Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial

JAMA. 2008 May 28;299(20):2413-22. doi: 10.1001/jama.299.20.2413.


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, setting, and patients: A concealed, randomized, multicenter, evaluator-blinded, parallel-group trial (the Cathedia 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. 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.

Main outcome measures: Rates of infectious complications, defined as catheter colonization on removal (primary end point), and catheter-related bloodstream infection.

Results: Patient and catheter characteristics, including duration of catheterization, were similar in both groups. More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%], respectively; P = .03). 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; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.62-1.16; P = .31). A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI (P for the interaction term < .001). Jugular catheterization significantly increased incidence of catheter colonization vs femoral catheterization (45.4 vs 23.7 per 1000 catheter-days; HR, 2.10; 95% CI, 1.13-3.91; P = .017) in the lowest tercile (BMI <24.2), whereas jugular catheterization significantly decreased this incidence (24.5 vs 50.9 per 1000 catheter-days; HR, 0.40; 95% CI, 0.23-0.69; P < .001) 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, respectively; P = .42).

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.

Trial registration: clinicaltrials.gov Identifier: NCT00277888.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Body Mass Index
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / methods
  • Catheterization, Peripheral / adverse effects*
  • Catheterization, Peripheral / methods
  • Catheters, Indwelling / microbiology
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Female
  • Femoral Vein*
  • Hematoma / epidemiology
  • Hematoma / etiology
  • Humans
  • Jugular Veins*
  • Male
  • Middle Aged
  • Morbidity
  • Prospective Studies
  • Renal Replacement Therapy / methods*
  • Risk
  • Sepsis / epidemiology
  • Sepsis / etiology
  • Thrombosis / epidemiology
  • Thrombosis / etiology

Associated data

  • ClinicalTrials.gov/NCT00277888