Tunneled infusion catheters: Increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access

PURPOSE: To compare the incidence of symptomatic venous thrombosis after tu nneled infusion catheter placement via the internal jugular vein (IJV) vers us the subclavian vein (SCV). MATERIALS AND METHODS: A retrospective analysis was performed of 774 cathet ers placed. Only patients with complete follow-up were included, which yiel ded a population of 279 catheters in 238 patients (166 in the SCV, 113 in t he IJV; total of 26,242 catheter days). All catheters were placed by interv entional radiologists with ultrasonographic (in IJV) or venographic tin SCV ) guidance. RESULTS: Initial complications were limited to one pneumothorax in the SCV group and one episode of oversedation in the IJV group. There was no differ ence in infection rates between the two sites (SVC vs IJV: 0.25 vs 0.32 per 100 catheter days; P >.99). The mean dwell time was slightly longer for SC V catheters (103 days) than for IJV catheters (79 days) (P = .04). Venous t hrombosis developed in 13% of patients (0.12 per 100 catheter days) with an SVC catheter placed as compared with in 3% (0.04 per 100 catheter days:) w ith an IJV catheter (P = .018). This difference persisted after adjustment for catheter size and side of placement (P = .025). The mean time to thromb osis was 36 days for SCV catheters and 142 days for IJV catheters. CONCLUSION: The IJV is the preferred site for tunneled infusion catheter pl acement because of the lower incidence of symptomatic venous thrombosis.