Review: Femoral and subclavian or

internal jugular venous catheters do not differ for bloodstream infections Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40:2479-85. Question Do femoral venous catheters increase risk for catheter-related bloodstream infection (CRBI) more than subclavian or internal jugular venous catheters? Review scope Included studies compared nontunneled central venous catheters (CVCs) inserted at femoral sites with those inserted at subclavian or internal jugular sites in adults. Outcomes were CRBIs (preva-lence and infections per 1000 catheter-days) and deep venous thrombosis (DVT). Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane Database of Systematic Reviews, Google.com, and reference lists were searched to October 2011 for published and unpublished randomized controlled trials (RCTs) and cohort studies. 2 RCTs (n = 1006 patients with 7511 catheter-days) and 8 cohort studies (n = 16 370 catheters with 106 141 catheter-days) met inclusion criteria. Only the results of RCTs are reported here. Both RCTs were done in intensive care units. Main results 1.5 CRBIs/1000 catheter-days occurred in patients with femoral catheters (2 RCTs) compared with 0.63 CRBIs/1000 catheter-days in those with subclavian catheters (1 RCT) and 2.3/1000 catheter-days in those with internal jugular catheters (1 RCT). In individual RCTs, femoral CVC insertion did not differ from subclavian or internal jugular CVC insertion for CRBIs (Table). Meta-analysis showed that femoral and subclavian or internal jugular catheters did not differ for DVT; heterogeneity of results was high (Table). Conclusion Femoral central venous catheters do not differ from subclavian or internal jugular catheters for catheter-related bloodstream infec-tions in critically ill adults