title: Vascular access sites for acute renal replacement in intensive care units.
abstract: OBJECTIVE
  Several temporary venous catheterizations are sometimes required for acute renal replacement therapy (RRT) in the intensive care unit (ICU). This study compares first and second catheterizations in the femoral and jugular veins in terms of patient safety.
  
  
  METHODS
  A crossover study from the catheter-dialysis randomized study (Cathedia), which was conducted among 736 critically ill adults requiring RRT, was performed. Catheter insertion complications, catheter-tip colonization, catheter dysfunction and urea reduction ratio (URR) were analyzed considering the crossover and longitudinal designs.
  
  
  RESULTS
  This study analyzed 134 patients who underwent two different sites of catheterization, 57 and 77 of whom were initially randomized in the femoral and jugular site, respectively. Using anatomic landmarks, time to insert a femoral catheter was shorter (P=0.01) and more successful (P=0.003) compared with catheterization in the jugular site. Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion (median, 14 days in both groups; hazard ratio, 0.99; 95% confidence interval, 0.61-1.59; P=0.96), as well as time to dysfunction. URRs were analyzed from 395 dialysis sessions (n=48 patients). No significant difference (P=0.49) in mean URR was detected between sessions performed through femoral (n=213; 50.9%) and jugular (n=182; 49.5%) dialysis catheters.
  
  
  CONCLUSIONS
  These results validate prior results of this study group and extend external validity to the second catheter used for RRT in the ICU. Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU.
authors.affiliation: Department of Biostatistics and Clinical Research, Centre Hospitalier Universitaire de Caen, France.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Dugué
authors.forename: Stéphanie P
authors.initials: SP
authors.lastname: Levesque
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Fischer
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.forename: Cédric
authors.initials: C
authors.lastname: Daubin
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D018592:Cross-Over Studies; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007362:Intensive Care Units; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000009:adverse effects; D014508:Urea / Q000378:metabolism
chemical_list: D014508:Urea
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