Document Detail


Complications of central venous catheters: internal jugular versus subclavian access--a systematic review.
MedLine Citation:
PMID:  11889329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Sibylle Ruesch; Bernhard Walder; Martin R Tramèr
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Critical care medicine     Volume:  30     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-03-12     Completed Date:  2002-03-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  454-60     Citation Subset:  AIM; IM    
Affiliation:
Division of Anaesthesiology, Department Anaesthesiology, Pharmacology, and Surgical Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Catheterization, Central Venous / 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:
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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