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.

A Cochrane review 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).

Ədəbiyyat

1. 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.