3SITES (jugular vs. subclavian)
Trial question
Is jugular vein catheterization superior to subclavian vein catheterization in ICU patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 1965
1965 patients (709 female, 1256 male).
Inclusion criteria: adult patients in the ICU.
Key exclusion criteria: age ≤ 18 years; only one site available for catheterization.
Interventions
N=984 jugular vein catheterization (catheter insertion in the jugular vein).
N=981 subclavian vein catheterization (catheter insertion in the subclavian vein).
Primary outcome
Catheter-related bloodstream infection and symptomatic deep vein thrombosis
23 events
11 events
23.0 events
17.3 events
11.5 events
5.8 events
0.0 events
Jugular vein
catheterization
Subclavian vein
catheterization
Significant
increase ▲
Significant increase in catheter-related bloodstream infection and symptomatic DVT (23 events vs. 11 events; HR 2.1, 95% CI 1 to 4.3).
Secondary outcomes
Significant increase in catheter tip colonization (104 events vs. 42 events; HR 2.5, 95% CI 1.7 to 3.5).
Significant increase in DVT (69 events vs. 20 events; HR 3.1, 95% CI 1.9 to 5).
No significant difference in major mechanical complications (12 events vs. 22 events; OR 0.5, 95% CI 0.3 to 1.1).
Conclusion
In adult patients in the ICU, jugular 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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