For a patient who needs only one type of infusion (e.g., antibiotics, crystalloid fluids, low‑osmolarity parenteral nutrition, or occasional blood draws), should I place a single‑lumen catheter or a double‑lumen catheter?

Single-Lumen Catheter Recommendation

For patients requiring only one type of infusion (antibiotics, crystalloid fluids, low-osmolarity parenteral nutrition, or occasional blood draws), place a single-lumen catheter. 1, 2

Evidence-Based Rationale

Infection Risk Reduction

• Multi-lumen catheters increase bacteremia risk 2-4 fold compared to single-lumen devices, with sepsis rates of 10-20% versus 0-5% for single-lumen catheters. 2
• For every 20 single-lumen catheters used instead of multi-lumen devices, one catheter-related bloodstream infection is prevented. 2
• The American College of Radiology explicitly recommends using the smallest diameter catheter with minimum number of lumens necessary to minimize complications. 1

Real-World Clinical Outcomes

• A large institutional study of over 4,000 catheter insertions demonstrated that dual-lumen catheters were required in only 50% of cases where they were initially requested, indicating systematic overuse. 3
• Switching to a single-lumen default policy resulted in:
  • Significant reductions in central line-associated bloodstream infections 3
  • Decreased catheter-related thrombosis 3
  • Lower reinsertion rates 3
  • Cost savings of approximately $1.1 million annually 3

Cost-Effectiveness Analysis

• In hospitals placing 1,000 PICCs annually, every 5% increase in single-lumen PICC use prevents 0.5 infections and 0.5 deep vein thrombosis events while saving $23,500. 4
• Moving from 25% to 50% single-lumen utilization saves approximately $119,283 per year with 10% overall cost reduction. 4

When Multi-Lumen Catheters Are Justified

Multi-lumen catheters should be reserved for specific clinical scenarios:

• Parenteral nutrition requiring dedicated lumen: When PN is administered, one lumen must be dedicated exclusively to PN, necessitating a second lumen for other therapies. 1, 2
• Multiple simultaneous incompatible infusions: When non-compatible medications require simultaneous administration. 1
• Continuous renal replacement therapy (CRRT): Double-lumen catheters are the standard for CRRT. 5

Critical Implementation Points

Catheter Selection Algorithm

1. Assess actual infusion needs (not anticipated "just in case" needs):

   • Single medication or fluid type → single-lumen catheter 1, 2
   • Parenteral nutrition + other therapies → multi-lumen with dedicated PN port 1, 2
   • Multiple simultaneous incompatible infusions → multi-lumen catheter 1

2. Default to single-lumen unless specific multi-lumen indication documented. 3, 6

Common Pitfalls to Avoid

• Do not place multi-lumen catheters "just in case" additional access might be needed later—this increases infection risk without clinical benefit. 3, 4
• Avoid the misconception that blood draws require a separate lumen—single-lumen catheters accommodate both infusion and blood sampling. 2
• Never use multiple lumens interchangeably—if a multi-lumen catheter is placed, maintain strict lumen designation (e.g., never sample blood from the PN lumen). 2

Infection Prevention Measures

• Implement strict aseptic technique for every lumen manipulation regardless of catheter type. 2
• Consider antimicrobial-coated catheters in high-risk patients (immunocompromised, prolonged catheterization >30 days). 1, 2
• Establish and follow strict protocols for catheter care—one study demonstrated zero catheter sepsis in both single- and double-lumen groups when rigorous protocols were maintained. 7

Supporting Evidence Quality

The recommendation prioritizes single-lumen catheters based on:

• 2017 ACR Appropriateness Criteria (highest-level guideline evidence) 1
• 2025 ESPEN/ESPGHAN consensus guidelines (Grade B recommendation) 2
• Multiple high-quality prospective studies demonstrating 50-93% reduction in complications 3, 4, 6

The single dissenting study 7 showing equivalent infection rates between single- and double-lumen catheters is from 1990 and involved only total parenteral nutrition patients with extremely strict protocols—this does not reflect typical hospital practice and is superseded by more recent, larger-scale evidence.