Complications of Central Venous Catheterization by Insertion Site

Parienti et al report in NEJM the finds of a trial regarding complications from central venous catheters depending on the insertion site. 

In this multicenter trial, they randomly assigned non-tunneled central venous catheterization in patients in the intensive care unit to the subclavian, jugular, or femoral veins.

The primary outcome measure was catheter-related bloodstream infection and symptomatic deep-vein thrombosis.

A total of 3471 catheters were inserted in 3027 patients. In the three-choice comparison, there were 8, 20, and 22 primary outcome events in the subclavian, jugular, and femoral groups, respectively (1.5, 3.6, and 4.6 per 1000 catheter-days; P=0.02). In pairwise comparisons, the risk of the primary outcome was significantly higher in the femoral group than in the subclavian group and in the jugular group than in the subclavian group, whereas the risk in the femoral group was similar to that in the jugular group. In the three-choice comparison, pneumothorax requiring chest-tube insertion occurred in 13 (1.5%) of the subclavian-vein insertions and 4 (0.5%) of the jugular-vein insertions.

The authors concluded that subclavian vein catheterization was associated with a lower risk of bloodstream infection and symptomatic thrombosis and a higher risk of pneumothorax than jugular vein or femoral vein catheterization.

N Engl J Med 2015; 373:1220-1229