Intravascular Complications of Central Venous Catheterization by Insertion Site
Jean-Jacques Parienti, Nicolas Mongardon, Bruno Mégarbane, Jean-Paul Mira, Pierre Kalfon, Antoine Gros, Sophie Marqué, Marie Thuong, Véronique Pottier, Michel Ramakers, Benoît Savary, Amélie Seguin, Xavier Valette, Nicolas Terzi, Bertrand Sauneuf, Vincent Cattoir, Leonard A Mermel, Damien du Cheyron, 3SITES Study Group, J P Mira, N Aissat, J Bardon, O Ben Hadj Salem, A Bougle, W Bougoin, S Bourcier, A Chabrol, B Champigneulle, R Chentouh, M Commereuc, L Contentin, F Daviaud, A Flahault, G Franchineau, J Frija, G Geri, M Ghalayani, A Gruner, L Guillemet, B Habr, Y Haddad, C Harmouche, P Jaubert, J Joffre, A Le Gall, J F Llitjos, N Lucas, J Massot, T Morichau Beauchant, A Neuschwander, Y Nguyen, F Perier, N Peron, M Pineton de Chambrun, J Raphalen, A Rodrigues, B Mégarbane, M Annonay, F Baud, D Benchetrit, V Boileve, J Caudron, A Ceccaldi, J Chelly, H Chopra, P Degrell, F Dehoet, N Deye, D Diab, J M Ekhérian, S Elhatimi, F Huang, M Jamme, P H Jost, P A Lampson, M Lecorre, L Legrand, A Le Joncour, Y Luque, I Malissin, B Megarbane, W Nahmiash, M Nunez Peredo, A Nuzzo, A Potier, J Serbource-Goguel, V Spagnoli, L Sutteblin, D Vodovar, C Zylberfajn, D du Cheyron, X Balaire, C Boisselier, C Bouffard, Q Cabrera, A Dalbera, H de Boysson, D du Cheyron, M Dufour-Trivini, S Goursaud, A Kamga, T Lamy, F Le Gall, C Le Reun, D Legouis, M Lermuzeaux, T Ngo, F Parazols, F Prevost, A Rauline, R Riftovski, A Seguin, A Senez, X Valette, L Varin, J Wain-Hobson, V Pottier, C Abadie, F Besson, M Boutros, A Coquerel, S Goursaud, C Persyn, A Gros, E Boissier, A Constant, J Iserentant, A Lancelot, H Nougue, L Roulin, P Kalfon, M Chilles, P Kalfon, Y Ancedy, Q Belot, C Pinier, B Andrieu, B Aupy, M Thuong, A Patrascu, J Richecoeur, M Seghouani, N Suh, S Marqué, E Kantor, P Hazera, M Ramakers, B Savary, N Mongardon, L Kohou-Kone, F Godde, J J Dutheil, N Marin, F Fournel, D Rots, S P Levesque, Mathieu Eury, F Chaillot, Jean-Jacques Parienti, Nicolas Mongardon, Bruno Mégarbane, Jean-Paul Mira, Pierre Kalfon, Antoine Gros, Sophie Marqué, Marie Thuong, Véronique Pottier, Michel Ramakers, Benoît Savary, Amélie Seguin, Xavier Valette, Nicolas Terzi, Bertrand Sauneuf, Vincent Cattoir, Leonard A Mermel, Damien du Cheyron, 3SITES Study Group, J P Mira, N Aissat, J Bardon, O Ben Hadj Salem, A Bougle, W Bougoin, S Bourcier, A Chabrol, B Champigneulle, R Chentouh, M Commereuc, L Contentin, F Daviaud, A Flahault, G Franchineau, J Frija, G Geri, M Ghalayani, A Gruner, L Guillemet, B Habr, Y Haddad, C Harmouche, P Jaubert, J Joffre, A Le Gall, J F Llitjos, N Lucas, J Massot, T Morichau Beauchant, A Neuschwander, Y Nguyen, F Perier, N Peron, M Pineton de Chambrun, J Raphalen, A Rodrigues, B Mégarbane, M Annonay, F Baud, D Benchetrit, V Boileve, J Caudron, A Ceccaldi, J Chelly, H Chopra, P Degrell, F Dehoet, N Deye, D Diab, J M Ekhérian, S Elhatimi, F Huang, M Jamme, P H Jost, P A Lampson, M Lecorre, L Legrand, A Le Joncour, Y Luque, I Malissin, B Megarbane, W Nahmiash, M Nunez Peredo, A Nuzzo, A Potier, J Serbource-Goguel, V Spagnoli, L Sutteblin, D Vodovar, C Zylberfajn, D du Cheyron, X Balaire, C Boisselier, C Bouffard, Q Cabrera, A Dalbera, H de Boysson, D du Cheyron, M Dufour-Trivini, S Goursaud, A Kamga, T Lamy, F Le Gall, C Le Reun, D Legouis, M Lermuzeaux, T Ngo, F Parazols, F Prevost, A Rauline, R Riftovski, A Seguin, A Senez, X Valette, L Varin, J Wain-Hobson, V Pottier, C Abadie, F Besson, M Boutros, A Coquerel, S Goursaud, C Persyn, A Gros, E Boissier, A Constant, J Iserentant, A Lancelot, H Nougue, L Roulin, P Kalfon, M Chilles, P Kalfon, Y Ancedy, Q Belot, C Pinier, B Andrieu, B Aupy, M Thuong, A Patrascu, J Richecoeur, M Seghouani, N Suh, S Marqué, E Kantor, P Hazera, M Ramakers, B Savary, N Mongardon, L Kohou-Kone, F Godde, J J Dutheil, N Marin, F Fournel, D Rots, S P Levesque, Mathieu Eury, F Chaillot
Abstract
Background: Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for major complications.
Methods: In this multicenter trial, we randomly assigned nontunneled central venous catheterization in patients in the adult intensive care unit (ICU) to the subclavian, jugular, or femoral vein (in a 1:1:1 ratio if all three insertion sites were suitable [three-choice scheme] and in a 1:1 ratio if two sites were suitable [two-choice scheme]). The primary outcome measure was a composite of catheter-related bloodstream infection and symptomatic deep-vein thrombosis.
Results: 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 (hazard ratio, 3.5; 95% confidence interval [CI], 1.5 to 7.8; P=0.003) and in the jugular group than in the subclavian group (hazard ratio, 2.1; 95% CI, 1.0 to 4.3; P=0.04), whereas the risk in the femoral group was similar to that in the jugular group (hazard ratio, 1.3; 95% CI, 0.8 to 2.1; P=0.30). In the three-choice comparison, pneumothorax requiring chest-tube insertion occurred in association with 13 (1.5%) of the subclavian-vein insertions and 4 (0.5%) of the jugular-vein insertions.
Conclusions: 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. (Funded by the Hospital Program for Clinical Research, French Ministry of Health; ClinicalTrials.gov number, NCT01479153.).
Source: PubMed