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Femoral vs. Subclavian Venous Catheterization

Femoral or subclavian veins often are catheterized to gain central venous access. These researchers sought to determine whether there are important differences in complication rates at these 2 sites.

In a trial conducted in 8 intensive care units in France, 289 patients who required central venous catheters in nonemergency situations were randomized to receive either femoral or subclavian venous catheters. Four pneumothoraces occurred in the subclavian group, and 2 hematomas that required transfusion or surgery occurred in the femoral group; otherwise, mechanical complications did not differ between the 2 groups. However, catheter-related infectious complications were significantly more common in the femoral group than in the subclavian group (20 percent vs. 5 percent), and clinical sepsis was slightly more common in the femoral group (4.4 percent vs. 1.5 percent, P=0.07). Duplex Doppler ultrasonography was performed in most patients, and catheter-related thromboses were detected significantly more frequently in patients with femoral catheters (22 percent vs. 2 percent). Complete thrombosis of the vein occurred in 7 femoral patients and in no subclavian patients.

Comment: These findings suggest that, as long as experienced physicians are available and the pneumothorax rate is low, subclavian vein catheterization is preferable to femoral vein catheterization because of lower rates of infection and thrombosis. However, in occasional cases, the femoral route might be preferable for anatomic or medical reasons.

— AS Brett

Published in Journal Watch General Medicine August 21, 2001

Citation(s):

Merrer J et al. Complications of femoral and subclavian venous catheterization in critically ill patients: A randomized controlled trial. JAMA 2001 Aug 8 286 700-707.

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