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Evidence summaries

Subclavian Versus Femoral Central Venous Access Site in Patients Requiring Long-Term Intravenous Therapy

Subclavian central venous access site appears to be preferable to femoral access site because of lower risks of infectious and thrombotic complications. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 1 study with a total of 293 subjects. No studies compared directly jugular with subclavian central venous access or catheter-related complications according to catheter circumference size.

1. Infectious complications (colonization with or without sepsis): RR was 4.57 (95% CI 1.95 to 10.71) favouring subclavian over femoral access. Major infectious complications (sepsis with or without bacteremia) the RR was 3.04 (95% CI 0.63 to 14.82), colonized catheter of gram positive micro-organisms the RR was 3.65 (95% CI 1.40 to 9.56) and colonized catheter of gram negative micro-organisms the RR was 5.41 (95% CI 1.61 to 18.15) all favouring subclavian access.

2. Mechanical complications (arterial puncture, minor bleeding, haematoma, misplaced catheter): the RR was 0.92 (95% Cl 0.56 to 1.51) favouring subclavian access.

3. Catheter-related thromboses (fibrin sleeves, major and complete thrombosis): the RR was 11.53 (95% CI 2.80 to 47.52) favouring subclavian access.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).

References

  • Hamilton HC, Foxcroft DR. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database Syst Rev 2007 Jul 18;(3):CD004084. [PubMed]

Primary/Secondary Keywords