Complications of central venous catheters: Internal jugular versus subclavian access—A systematic review

By S. Ruesch, B. Walder, M. Tramèr. Critical Care Medicine, 2002

636 citations recorded by the source corpus.

Objective To test whether complications happen more often with the internal jugular or the subclavian central venous approach. Data Source Systematic search (MEDLINE, Cochrane Library, EMBASE, bibliographies) up to June 30, 2000, with no language restriction. Study Selection Reports on prospective comparisons of internal jugular vs. subclavian catheter insertion, with dichotomous data on complications. Data Extraction No valid randomized trials were found. Seventeen prospective comparative trials with data on 2,085 jugular and 2,428 subclavian catheters were analyzed. Meta-analyses were performed with relative risk (RR) and 95% confidence interval (CI), using fixed and random effects models. Data Synthesis In six trials (2,010 catheters), there were significantly more arterial punctures with jugular catheters compared with subclavian (3.0% vs. 0.5%, RR 4.70 [95% CI, 2.05–10.77]). In six trials (1,299 catheters), there were significantly less malpositions with the jugular access (5.3% vs. 9.3%, RR 0.66 [0.44–0.99]). In three trials (707 catheters), the incidence of bloodstream infection was 8.6% with the jugular access and 4.0% with the subclavian access (RR 2.24 [0.62–8.09]). In ten trials (3,420 catheters), the incidence of hemato- or pneumothorax was 1.3% vs. 1.5% (RR 0.76 [0.43–1.33]). In four trials (899), the incidence of vessel occlusion was 0% vs. 1.2% (RR 0.29 [0.07–1.33]). Conclusions There are more arterial punctures but less catheter malpositions with the internal jugular compared with the subclavian access. There is no evidence of any difference in the incidence of hemato- or pneumothorax and vessel occlusion. Data on bloodstream infection are scarce. These data are from nonrandomized studies; selection bias cannot be ruled out. In terms of risk, the data most likely represent a best case scenario. For rational decision-making, randomized trials are needed.

Subfields: Emergency Medical Services, Internal Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/42d6c38e96462bbdebcde34551e0bb6873653728

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

H. Loveday
J. Browne
J. Prieto
M. Wilcox
A. Bak
A. Tingle
M. Golsorkhi
UK Department of Health

Citations in the corpus

Guidelines for the prevention of intravascular catheter-related infections. (2011, neutral): “In retrospective observational studies, catheters inserted into an internal jugular vein have usually been associated with higher risk for colonization and/or CRBSI than those inserted into a subclavian.(37-47) Similar findings were noted in neonates in a single retrospective study.”
epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England (2007, background): “345, 408, [426] [427] [428] [429] [430] [431] [432] [433] [434] Guideline developers suggested that internal jugular insertion sites may pose a greater risk for infection because of their proximity to oropharyngeal secretions and because CVCs at this site are difÀ cult to immobilise.”
Guidelines for the prevention of intravascular catheter-related infections. (2002, neutral): “, pneumothorax, subclavian artery puncture, subclavian vein laceration, subclavian vein stenosis, hemothorax, thrombosis, air embolism, and catheter misplacement) [37–53].”
Guidelines for the prevention of intravascular catheter-related infections. (2002, neutral): “, pneumothorax, subclavian artery puncture, subclavian vein laceration, subclavian vein stenosis, hemothorax, thrombosis, air embolism, and catheter misplacement) [37–53].”