3SITES (femoral vs. subclavian)
Trial question
Is femoral vein catheterization superior to subclavian vein catheterization in ICU patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
35.0% female
65.0% male
N = 1753
1753 patients (611 female, 1142 male)
Inclusion criteria: adult patients in the ICU
Key exclusion criteria: age ≤ 18 years; only one site available for catheterization
Interventions
N=875 femoral vein catheterization (catheter insertion in the femoral vein)
N=878 subclavian vein catheterization (catheter insertion in the subclavian vein)
Primary outcome
Catheter-related bloodstream infection and symptomatic deep vein thrombosis
25
8
25.0 events
18.8 events
12.5 events
6.3 events
0.0 events
Femoral vein
catheterization
Subclavian vein
catheterization
Significant
increase ▲
Significant increase in catheter-related bloodstream infection and symptomatic DVT (25 events vs. 8 events; HR 3.5, 95% CI 1.5 to 7.8)
Secondary outcomes
Significant increase in catheter tip colonization (107 events vs. 39 events; HR 3.4, 95% CI 2.4 to 5)
Significant increase in DVT (46 events vs. 19 events; HR 3, 95% CI 1.7 to 5.3)
Significant decrease in major mechanical complications (6 events vs. 18 events; OR 0.3, 95% CI 0.1 to 0.8)
Conclusion
In adult patients in the ICU, femoral vein catheterization was inferior to subclavian vein catheterization with respect to a catheter-related bloodstream infection and symptomatic DVT.
Reference
Jean-Jacques Parienti, Nicolas Mongardon, Bruno Mégarbane et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 2015 Sep 24;373(13):1220-9.
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