Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches.
OBJECTIVE
To compare the technical success and immediate and long-term outcomes of tunneled central venous catheters placed in comparative cohorts via the subclavian vein (SCV) and the internal jugular vein (IJV) routes.


METHODS
This was a prospective observational single-center study of consecutive procedures. Between November 1993 and June 1995, 99 catheters 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 cohorts 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 group and technical success was 100% versus 97% in the SCV group, but this did not reach statistical significance. The procedure-related pneumothorax rate and the rate of symptomatic venous thrombosis were significantly lower in the IJV cohort (P = .023, P = .015). Fewer catheters were removed prematurely 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 tunneled central venous catheters.
Macdonald
S
S
Department of Radiology, Gartnavel General Hospital, West Glasgow Hospitals, University NHS Trust, United Kingdom. sumaira@primedia.co.uk
Watt
A J
AJ
McNally
D
D
Edwards
R D
RD
Moss
J G
JG
D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013350:Subclavian Vein; D013997:Time Factors