| Complications of central venous catheters: internal jugular versus subclavian access--a systematic review. | |
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MedLine Citation:
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PMID: 11889329 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To test whether complications happen more often with the internal jugular or the subclavian central venous approach. DATA SOURCE: Systematic search (MEDLINE, Cochrane Library, EMBASE, bibliographies) up to June 30, 2000, with no language restriction. STUDY SELECTION: Reports on prospective comparisons of internal jugular vs. subclavian catheter insertion, with dichotomous data on complications. DATA EXTRACTION: No valid randomized trials were found. Seventeen prospective comparative trials with data on 2,085 jugular and 2,428 subclavian catheters were analyzed. Meta-analyses were performed with relative risk (RR) and 95% confidence interval (CI), using fixed and random effects models. DATA SYNTHESIS: In six trials (2,010 catheters), there were significantly more arterial punctures with jugular catheters compared with subclavian (3.0% vs. 0.5%, RR 4.70 [95% CI, 2.05-10.77]). In six trials (1,299 catheters), there were significantly less malpositions with the jugular access (5.3% vs. 9.3%, RR 0.66 [0.44-0.99]). In three trials (707 catheters), the incidence of bloodstream infection was 8.6% with the jugular access and 4.0% with the subclavian access (RR 2.24 [0.62-8.09]). In ten trials (3,420 catheters), the incidence of hemato- or pneumothorax was 1.3% vs. 1.5% (RR 0.76 [0.43--1.33]). In four trials (899), the incidence of vessel occlusion was 0% vs. 1.2% (RR 0.29 [0.07-1.33]). CONCLUSIONS: There are more arterial punctures but less catheter malpositions with the internal jugular compared with the subclavian access. There is no evidence of any difference in the incidence of hemato- or pneumothorax and vessel occlusion. Data on bloodstream infection are scarce. These data are from nonrandomized studies; selection bias cannot be ruled out. In terms of risk, the data most likely represent a best case scenario. For rational decision-making, randomized trials are needed. |
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Authors:
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Sibylle Ruesch; Bernhard Walder; Martin R Tramèr |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Critical care medicine Volume: 30 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2002 Feb |
Date Detail:
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Created Date: 2002-03-12 Completed Date: 2002-03-27 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 454-60 Citation Subset: AIM; IM |
Affiliation:
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Division of Anaesthesiology, Department Anaesthesiology, Pharmacology, and Surgical Intensive Care, University Hospitals of Geneva, Geneva, Switzerland. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Catheterization, Central Venous
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adverse effects*,
methods* Equipment Failure / statistics & numerical data Hemothorax / epidemiology, etiology Humans Jugular Veins* Pneumothorax / epidemiology, etiology Risk Sepsis / epidemiology, etiology Subclavian Vein* Vascular Diseases / epidemiology, etiology |
| Comments/Corrections | |
Comment In:
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Crit Care. 2003 Dec;7(6):397-9
[PMID:
14624670
]
Crit Care Med. 2002 Feb;30(2):486-7 [PMID: 11889338 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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