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Comment & Response
May 2015

Insertion Site for Central Venous Catheters

Author Affiliations
  • 1Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 2Division of Infectious Diseases, Department of Epidemiology & Infection Control, Rhode Island Hospital, Providence
  • 3Department of Biostatistics & Clinical Research, Côte de Nacre University Hospital Center, Caen, France
  • 4Risques Microbiens, Faculté de Médecine, Université de Caen Basse-Normandie, Caen, France
JAMA Intern Med. 2015;175(5):861-862. doi:10.1001/jamainternmed.2015.36

To the Editor Patel and colleagues1(p1726) wrote that central venous catheters should be placed in the internal jugular vein “which carries a lower risk of infection than the subclavian route.” This statement is unsubstantiated from studies published to date, and this is not the recommendation in recent guidelines.2,3 For short-term, nontunneled central venous catheters inserted in the intensive care unit, our meta-analysis suggested that subclavian insertion is associated with a lower risk of infection.4 In addition, the anatomic site used to insert a port for administration of chemotherapy had no effect on infectious and noninfectious complications.5 Ultimately, decisions regarding which anatomic site to insert a central venous catheter depend on patient-specific risk factors (eg, obesity, bleeding diathesis, hyperinflation of the lungs), availability of ultrasound guidance, and experience of the inserter.

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