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Merrer J, De Jonghe B, Golliot F, et al. Complications of Femoral and Subclavian Venous Catheterization in Critically Ill Patients: A Randomized Controlled Trial. JAMA. 2001;286(6):700–707. doi:10.1001/jama.286.6.700
Author Affiliations: Service de Réanimation Médicale (Drs Merrer, De Jonghe, and Outin) and Service de Réanimation Chirurgicale (Dr Raffy), Centre Hospitalier de Poissy/St Germain-en-Laye, Poissy, France; Centre de Coordination et de Lutte Contre les Infections Nosocomiales de Paris-Nord (Mr Golliot) and Service de Réanimation Polyvalente, Hôpital Saint Joseph (Dr Misset), Paris, France; Département d'Urgence Réanimation, Centre Hospitalo-Universitaire de Nîmes, Nîmes, France (Dr Lefrant); Service de Réanimation Polyvalente, Centre Hospitalier de Mantes-la-Jolie, Mantes-la-Jolie, France (Dr Barre); Service de Réanimation Médicale, Centre Hospitalier de Dieppe, Dieppe, France (Dr Rigaud); Service de Réanimation Polyvalente, Centre Hospitalier de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France (Dr Casciani); Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Strasbourg, Strasbourg, France (Dr Bosquet); Service de Réanimation Médicale, Centre Hospitalo-Universitaire Henri Mondor, Creteil, France (Dr Brun-Buisson); and Service de Réanimation Medico-Chirurgicale, Institut Gustave-Roussy, Villejuif, France (Dr Nitenberg).
Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA.
Context Whether venous catheterization at the femoral site is associated with
an increased risk of complications compared with that at the subclavian site
Objective To compare mechanical, infectious, and thrombotic complications of femoral
and subclavian venous catheterization.
Design and Setting Concealed, randomized controlled clinical trial conducted between December
1997 and July 2000 at 8 intensive care units (ICUs) in France.
Patients Two hundred eighty-nine adult patients receiving a first central venous
Interventions Patients were randomly assigned to undergo central venous catheterization
at the femoral site (n = 145) or subclavian site (n = 144).
Main Outcome Measures Rate and severity of mechanical, infectious, and thrombotic complications,
compared by catheterization site in 289, 270, and 223 patients, respectively.
Results Femoral catheterization was associated with a higher incidence rate
of overall infectious complications (19.8% vs 4.5%; P<.001;
incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious
complications (clinical sepsis with or without bloodstream infection, 4.4%
vs 1.5%; P = .07; incidence density of 4.5 vs 1.2
per 1000 catheter-days), as well as of overall thrombotic complications (21.5%
vs 1.9%; P<.001) and complete thrombosis of the
vessel (6% vs 0%; P = .01); rates of overall and
major mechanical complications were similar between the 2 groups (17.3% vs
18.8 %; P = .74 and 1.4% vs 2.8%; P = .44, respectively). Risk factors for mechanical complications were
duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI],
1.03-1.08 per additional minute; P<.001); insertion
in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P
= .001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P = .03). The only factor associated with infectious complications
was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter
decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P = .03). Femoral catheterization was the only risk factor
for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001).
Conclusion Femoral venous catheterization is associated with a greater risk of
infectious and thrombotic complications than subclavian catheterization in
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