Friday June 6, 2008
At last something favouring femoral access ! - Cathedia Study

A recent study (Cathedia Study) published in favour of femoral access 1. Study was a multicenter 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.

Context: 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.

Design: 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.

Intervention: Patients were randomized to receive jugular or femoral vein catheterization by operators experienced in placement at both sites.

End-point: Rates of infectious complications, defined as

1. Catheter colonization on removal (primary end point), and
2. Catheter-related bloodstream infection

Patient and catheter characteristics, including duration of catheterization, were similar in both groups.


Results:

• More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%]).
• 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).
• A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI. Jugular catheterization significantly increased incidence of catheter colonization vs femoral catheterization (45.4 vs 23.7 per 1000 catheter-days) in the lowest tercile (BMI less than 24.2), whereas jugular catheterization significantly decreased this incidence (24.5 vs 50.9 per 1000 catheter-days) 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)

Conclusion: 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.



References: click to get abstract/article

1. Femoral vs Jugular Venous Catheterization and Risk of Nosocomial Events in Adults Requiring Acute Renal Replacement Therapy - A Randomized Controlled Trial , JAMA. 2008;299(20):2413-2422.