Parienti JJ et al. (2008) Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 299: 2413–2422

Jugular vein catheters are thought to be less prone to infection than femoral vein catheters, but evidence from randomized trials has been lacking. Now, results of the Cathedia study in France suggest that there is no significant difference in the rate of infection between jugular and femoral access in critically ill patients requiring acute renal replacement therapy (RRT).

Parienti et al. conducted a multicenter, prospective, evaluator-blinded trial in which 750 adults were randomly allocated to undergo femoral vein or jugular temporary vein catheterization for short-term vascular access for RRT. The incidence of catheter colonizations per 1,000 catheter days was 40.8 (95% CI 29.3–55.4) in the femoral group and 35.7 (95% CI 25.0–49.5) in the jugular group (P = 0.54). Femoral catheterization was associated with 1.5 (95% CI 0.1–6.4) bloodstream infections per 1,000 days compared with 2.3 (95% CI 0.3–7.7) for jugular catheteriztion (P = 0.42). The risk of catheter colonization increased with BMI in the femoral group, but not in the jugular group. Jugular insertion, mainly by use of the landmark technique, had a higher rate of mechanical complications than femoral insertion. The rate of hematoma formation was 3.6% in the jugular group compared with 1.1% in the femoral group (P = 0.03).

The authors suggest that jugular catheterization should be strongly considered for patients with a high BMI who require acute RRT, but that femoral catheterization by an experienced operator might reduce the likelihood of mechanical complications compared with jugular catheterization in nonobese, bed-bound, critically ill patients, without increasing the risk of infection.