Monday, 14 March 2016

Intravascular complications of central venous catheterization by insertion site. NJEM September 2015.

In this multicenter trial, 3471 central venous catheters were assigned to ICU patients to the subclavian, jugular or femoral vein. The primary outcome was a composite of major catheter-related bloodstream infection and symptomatic DVT.

Key points for this article:

  1. Subclavian line is associated with less bacterial bioburden (longer subcutaneous course to the entry of vein); less likelihood of disruption of dressing) - i.e. less colonisation, which is also associated with less catheter related infection and LESS deep vein thrombosis. This is most important when the catheter is going to be used for longer term.
  2. Mechanical complications of pneumothorax was higher in subclavian approach. 
  3. Considering infectious, thrombotic and mechanical complications all together – there is little difference between the three approaches. Mechanical complications can be reduced by improved skills and ultrasound use for subclavian approach.
ML

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