Jugular Access is Not Safer

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Jugular venous access for short-term dialysis in severely ill adult patients does not decrease infection risk compared with femoral access, except among those with high BMI, French researchers reported in the Journal of the American Medical Association (2008;299:2413-2422).

Jean-Jacques Parienti, MD, of Côte de Nacre University Hospital Center in Caen, and colleagues randomized 750 patients to receive either femoral or jugular catheterization for renal replacement therapy. The risk of catheter colonization at removal (the primary end point) was similar in the femoral or jugular groups (incidence of 40.8 vs. 35.7 per 1,000 catheter-days).

 

Among patients in the lowest BMI tercile (less than 24.2 kg/m2), however, jugular catheterization was associated with a twofold greater risk of colonization compared with femoral catheterization.

Among patients in the highest BMI tercile (greater than 28.4 kg/m2), jugular catheterization significantly decreased the risk of colonization by 60%. The groups had similar rates of catheter-related bloodstream infections, but more he-matomas occurred in the jugular access group. (3.6% vs. 1.1%).

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