Complications of femoral and subclavian venous catheterization in critically ill patients - A randomized controlled trial

Context Whether venous catheterization at the femoral site is associated wi th an increased risk of complications compared with that at the subclavian site is debated. Objective To compare mechanical, infectious, and thrombotic complications o f femoral and subclavian venous catheterization. Design and Setting Concealed, randomized controlled clinical trial conducte d between December 1997 and July 2000 at 8 intensive care units (ICUs) in F rance. Patients Two hundred eighty-nine adult patients receiving a first central v enous catheter. Interventions Patients were randomly assigned to undergo central venous cat heterization at the femoral site (n=145) or subclavian site (n=144). Main Outcome Measures Rate and severity of mechanical, infectious, and thro mbotic complications, compared by catheterization site in 289, 270, and 223 patients, respectively. Results Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence dens ity of 20 vs 3.7 per 1000 catheter-days) and of major infectious complicati ons (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P =.07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as o f overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thr ombosis of the vessel (6% vs 0%; P=.01); rates of overall and major mechani cal complications were similar between the 2 groups (17.3% vs 18.8%; P=.74 and 1.4% vs 2.8%; P=.44, respectively). Risk factors for mechanical complic ations were duration of insertion (odds ratio [OR], 1.05; 95% confidence in terval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of th e centers (OR, 4.52; 95% CI, 1.81-11.23; P=.001); and insertion during the night (OR, 2.06; 95% Cl, 1.04-4.08; P=.03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4 .83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the cathete r decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P=.03). Femoral catheterization was the only risk factor for thrombotic com plications (OR, 14.42; 95% CI, 3.33-62.57; P<.001). Conclusion Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.