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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