title: Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial.
abstract: BACKGROUND
  Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access.
  
  
  OBJECTIVE
  To determine whether jugular catheterization decreases the risk of nosocomial complications compared with femoral catheterization.
  
  
  METHODS
  A concealed, randomized, multicenter, evaluator-blinded, parallel-group trial (the Cathedia Study) of 750 patients from a network of 9 tertiary care university medical centers and 3 general hospitals in France conducted between May 2004 and May 2007. The severely ill, bed-bound adults had a body mass index (BMI) of less than 45 and required a first catheter insertion for renal replacement therapy.
  
  
  METHODS
  Patients were randomized to receive jugular or femoral vein catheterization by operators experienced in placement at both sites.
  
  
  METHODS
  Rates of infectious complications, defined as catheter colonization on removal (primary end point), and catheter-related bloodstream infection.
  
  
  RESULTS
  Patient and catheter characteristics, including duration of catheterization, were similar in both groups. More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%], respectively; P = .03). The risk of catheter colonization at removal did not differ significantly between the femoral and jugular groups (incidence of 40.8 vs 35.7 per 1000 catheter-days; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.62-1.16; P = .31). A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI (P for the interaction term < .001). Jugular catheterization significantly increased incidence of catheter colonization vs femoral catheterization (45.4 vs 23.7 per 1000 catheter-days; HR, 2.10; 95% CI, 1.13-3.91; P = .017) in the lowest tercile (BMI <24.2), whereas jugular catheterization significantly decreased this incidence (24.5 vs 50.9 per 1000 catheter-days; HR, 0.40; 95% CI, 0.23-0.69; P < .001) in the highest tercile (BMI >28.4). The rate of catheter-related bloodstream infection was similar in both groups (2.3 vs 1.5 per 1000 catheter-days, respectively; P = .42).
  
  
  CONCLUSIONS
  Jugular venous catheterization access does not appear to reduce the risk of infection compared with femoral access, except among adults with a high BMI, and may have a higher risk of hematoma.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00277888.
authors.affiliation: Department of Biostatistics and Clinical Research, Côte de Nacre University Hospital Center, Ave de la Côte de Nacre, 14033 Caen CEDEX, France. parienti-jj@chu-caen.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Marina
authors.initials: M
authors.lastname: Thirion
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Abdelali
authors.initials: A
authors.lastname: Ouchikhe
authors.forename: Andrea
authors.initials: A
authors.lastname: Polito
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Sophie
authors.initials: S
authors.lastname: Marqué
authors.forename: Benoît
authors.initials: B
authors.lastname: Misset
authors.forename: Norair
authors.initials: N
authors.lastname: Airapetian
authors.forename: Claire
authors.initials: C
authors.lastname: Daurel
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Michel
authors.initials: M
authors.lastname: Ramakers
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Coutour
authors.forename: Cédric
authors.initials: C
authors.lastname: Daubin
authors.forename: Pierre
authors.initials: P
authors.lastname: Charbonneau
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005268:Femoral Vein; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000379:methods*; D012306:Risk; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology