Procedures · Where to site a central line
Intravascular Complications of Central Venous Catheterization by Insertion Site
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Subclavian vein insertion |
| Control | Internal jugular or femoral vein insertion |
| Population | 3027 patients receiving 3471 catheters |
| Follow-up | Catheter dwell time |
| Primary endpoint | Composite of catheter-related bloodstream infection and symptomatic deep-vein thrombosis |
| Result | In the three-choice comparison there were 8, 20 and 22 primary outcome events in the subclavian, jugular and femoral groups respectively. Subclavian access carried a lower risk of bloodstream infection and symptomatic thrombosis but a higher risk of pneumothorax. |
| Secondary endpoints | Pneumothorax, mechanical complications, insertion failure |
In this trial, 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.
The trial authors, in the published abstract
Gives the trade explicitly rather than declaring a winner, which is what makes it usable: choose the site by which complication the patient can least afford. Predates routine ultrasound guidance for subclavian access, which may narrow the pneumothorax gap.
Parienti JJ, Mongardon N, Mégarbane B, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med 2015 Sep 24;373(13):1220-9.