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Nursing issues
Randomised controlled trial
Subclavian site should be preferred for central venous access
  1. Bruno Mourvillier,
  2. Aguila Radjou,
  3. Jean-Francois Timsit
  1. Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
  1. Correspondence to: Dr Bruno Mourvillier, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Réanimation Médicale et Infectieuse, Hopital Bichat Claude Bernard, 46 Rue Henri Huchard, 75877 Paris cedex 18, France; bruno.mourvillier{at}aphp.fr

https://doi.org/10.1136/eb-2015-102269

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    Commentary on: Parienti JJ, Mongardon N, Mégarbane B, et al., 3SITES Study Group. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med 2015;373:1220–9.OpenUrlCrossRefPubMed

    Implications for practice and research

    • Subclavian site should be preferred for central venous access (CVA) with a low risk of pneumothorax.

    • Excluding patients before randomisation represents a selection bias. Post hoc sensitivity analysis may reduce the bias without fully balancing it. An adjudication committee, unaware of study-group assignments, may compensate for the absence of feasible blindness.

    Context

    Infection, thrombosis and mechanical adverse events are complications of central venous catheterisation. Catheter-related bloodstream infection (CRBI) has a significant impact on morbidity, mortality and health costs.1 Randomised controlled trials (RCT) found that subclavian access was associated with a lower …

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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.