Francis Whalen, MD
Do femoral venous catheters increase risk for catheter-related bloodstream infection (CRBI) more than subclavian or internal jugular venous catheters?
Included studies compared nontunneled central venous catheters (CVCs) inserted at femoral sites with those inserted at subclavian or internal jugular sites in adults. Outcomes were CRBIs (prevalence and infections per 1000 catheter-days) and deep venous thrombosis (DVT).
MEDLINE, EMBASE/Excerpta Medica, Cochrane Database of Systematic Reviews, Google.com, and reference lists were searched to October 2011 for published and unpublished randomized controlled trials (RCTs) and cohort studies. 2 RCTs (n = 1006 patients with 7511 catheter-days) and 8 cohort studies (n = 16 370 catheters with 106 141 catheter-days) met inclusion criteria. Only the results of RCTs are reported here. Both RCTs were done in intensive care units.
1.5 CRBIs/1000 catheter-days occurred in patients with femoral catheters (2 RCTs) compared with 0.63 CRBIs/1000 catheter-days in those with subclavian catheters (1 RCT) and 2.3/1000 catheter-days in those with internal jugular catheters (1 RCT). In individual RCTs, femoral CVC insertion did not differ from subclavian or internal jugular CVC insertion for CRBIs (Table). Meta-analysis showed that femoral and subclavian or internal jugular catheters did not differ for DVT; heterogeneity of results was high (Table).
Femoral central venous catheters do not differ from subclavian or internal jugular catheters for catheter-related bloodstream infections in critically ill adults.
Femoral vs subclavian or internal jugular central venous catheters in critically ill adults*
*CRBI = catheter-related bloodstream infection; DVT = deep venous thrombosis; other abbreviations defined in Glossary. Weighted event rates, RRI, RRR, and CI calculated from risk ratios and control event rates in article using a random-effects model.
†P < 0.001 for heterogeneity across studies evaluating DVT (I2 = 94%). Femoral vs subclavian site (n = 223), RR 11.53, 95% CI 2.80 to 47.52; femoral vs internal jugular site (n = 151), RR 0.46, CI 0.21 to 1.01.
Francis Whalen. Review: Femoral and subclavian or internal jugular venous catheters do not differ for bloodstream infections. Ann Intern Med. 2012;157:JC5–8. doi: 10.7326/0003-4819-157-10-201211200-02008
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Published: Ann Intern Med. 2012;157(10):JC5-8.
Hospital Medicine, Hospital-Acquired Infections, Infectious Disease, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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