We appreciate the comments of Dr. Kaufman regarding his experience with multiple-lumen catheters. Our review did include data and references that have indicated a higher frequency of infection with multiple catheter ports than with a single catheter. We have, however, recognized the practical advantages of additional ports; our critical-care service inserted approximately 1,100 triple-lumen catheters in 1989. Until further data about rates of infection and other complications become available, we would caution against the routine placement of multiple-lumen catheters, especially when one or more ports would not be expected to be used for infusion.
The problem of septic central venous thrombosis and the related potential for right-sided endocarditis were considerations in our case discussion. An ultrasound examination of the subclavian vein and echocardiography were performed to evaluate these regions. We agree that prolonged antibiotic therapy would be warranted if septic central thrombophlebitis or endocarditis was identified. In our practice, however, these have been remarkably rare occurrences.
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