Comparison of technical success and outcome of tunneled catheters insertedvia the jugular and subclavian approaches

PURPOSE: To compare the technical success and immediate and long-term outco mes of tunneled central venous catheters placed in comparative cohorts via the subclavian vein (SCV) and the internal jugular vein (IJV) routes. MATERIALS AND METHODS: This was a prospective observational single-center s tudy of consecutive procedures, Between November 1993 and June 1995, 99 cat heters were placed via the SCV and between December 1997 and July 1998, 109 catheters were placed via the IJV, Procedural data were recorded in both c ohorts by completion of a proforma by the primary operator. RESULTS: Follow-up data were available in 96% of the SCV and 87% of the IJV cohorts. The average procedure time was significantly shorter in the IJV g roup and technical success was 100% versus 97% in the SCV group, but this d id not reach statistical significance. The procedure-related pneumothorax r ate and the rate of symptomatic venous thrombosis were significantly lower in the IJV cohort (P = .023, P = .015), Fewer catheters were removed premat urely due to sepsis in the IJV group (P = .043), CONCLUSIONS: The IJV route is associated with comparable technical success, and lower major procedural complication and venous thrombosis rates, with fewer catheters removed prematurely. The right IJV approach with ultrasound guidance is recommended as the route of choice for the placement of tunnel ed central venous catheters.