دورية أكاديمية
Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial.
| العنوان: | Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. |
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| المؤلفون: | Parienti, Jean-Jacques, Thirion, Marina, Megarbane, Bruno, Souweine, Bertrand, Ouchikhe, Abdelali, Polito, Andrea, Forel, Jean-Marie, Marque, Sophie, Misset, Benoît, Airapetian, Norair, Daurel, Claire, Mira, Jean-Paul, Ramakers, Michel, du Cheyron, Damien, Le Coutour, Xavier, Daubin, Cedric, Charbonneau, Pierre |
| المصدر: | JAMA: Journal of the American Medical Association, 299 (20), 2413-22 (2008) |
| بيانات النشر: | American Medical Association, 2008. |
| سنة النشر: | 2008 |
| مصطلحات موضوعية: | Aged, Body Mass Index, Catheterization, Central Venous/adverse effects/methods, Catheterization, Peripheral/adverse effects/methods, Catheters, Indwelling/microbiology, Cross Infection/epidemiology/etiology, Female, Femoral Vein, Hematoma/epidemiology/etiology, Humans, Jugular Veins, Male, Middle Aged, Morbidity, Prospective Studies, Renal Replacement Therapy/methods, Risk, Sepsis/epidemiology/etiology, Thrombosis/epidemiology/etiology, Human health sciences, Anesthesia & intensive care, Sciences de la santé humaine, Anesthésie & soins intensifs |
| الوصف: | 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. |
| نوع الوثيقة: | journal article http://purl.org/coar/resource_type/c_6501Test article |
| اللغة: | English |
| العلاقة: | urn:issn:0098-7484; urn:issn:1538-3598 |
| DOI: | 10.1001/jama.299.20.2413 |
| الوصول الحر: | https://orbi.uliege.be/handle/2268/245200Test |
| حقوق: | restricted access http://purl.org/coar/access_right/c_16ecTest info:eu-repo/semantics/restrictedAccess |
| رقم الانضمام: | edsorb.245200 |
| قاعدة البيانات: | ORBi |
| DOI: | 10.1001/jama.299.20.2413 |
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