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650 Internal Jugular Vein as the elective site for Central Venous Catheter (CVC) Insertion

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Héctor Rolando Martínez, MD , Hospital General Universitario Alicante, Alicante, Spain
Robert Camargo-Ángeles , Hospital General Universitario Alicante, Alicante, Spain
Julio Barrenengoa-Señudo , Hospital General Universitario Alicante, Alicante, Spain
Ana Carolina Martín-Ruiz , Hospital General Universitario Alicante, Alicante, Spain
Inmaculada Losa-Martínez , Hospital General Universitario Alicante, Alicante, Spain
César Villanueva-Ruiz , Hospital General Universitario Alicante, Alicante, Spain
Marina Fuster-Pérez , Hospital General Universitario Alicante, Alicante, Spain
José Sánchez-Payá , Hospital General Universitario Alicante, Alicante, Spain
Background: Numerous studies and clinical guidelines suggest that the subclavian vein should be chosen for central catheterization, mainly due to a lower rate of infectious complications. However, some studies have shown that in hands of trained personnel, both the subclavian and jugular vein have the same rate of catheter-related infections (CRI).

Objective: Demonstrate whether CVC inserted into internal jugular vein are associated with higher CRI than those inserted into the subclavian vein.

Methods: Prospective comparative study. Through a CRI Surveillance Program, were included for analysis all CVCs inserted in our hospital between February and October 2009. We collected the following measures: CVCs characteristics (type, location: jugular vs. subclavian, duration, number of lumens), risk factors for CRI (obesity, diabetes, neutropenia, malignancy, major surgery, burns, immunosuppression, chemotherapy, mechanical ventilation, peripheral line, nasogastric tube or urinary catheter); unit where the CVC was inserted. The presence of CRI was determined by microbiological surveillance, according to CDC criterias. Univariate analysis was performed for independent variables with chi2 test or “t” Student. The variables significantly associated with CRI, were finally included in a Cox regression model.

Results: 1130 CVCs were included, median duration (P25-P75) 7 days (4-11), insertion site: jugular 807 (71.4%), subclavian 323 (28.6%). CRI 47 (4.2%). After univariate analysis, significant association was found between CRI and the following variables: major surgery (p <0.000), peripheral line (p 0.008) and mechanical ventilation (p 0.020). No significant difference was found between jugular or subclavian vein and CRI, being slightly higher in the subclavian CVCs (5.0% vs. 3.8%, p 0.398). In multivariate analisis with Cox regression, only the presence of mechanical ventilation was significantly associated with CRI (HR: 1.88, p 0.29). The insertion in internal jugular vein was not associated with increased risk of CRI (HR 0.85, p 0.626).

Conclusions:

In our study, the CVCs inserted into internal jugular vein, were not associated with greater CRI than those inserted into subclavian vein. To avoid CRIs, it is possible that the election between internal jugular vein or subclavian vein should be based on operator experience.