Intravascular Complications of Central Venous Catheterization by Insertion Site

Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for major complications. In a multicenter trial, Parienti et al randomly assigned nontunneled central venous catheterization in patients in the adult intensive care unit 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.

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.

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