Selection of Catheter Insertion Site.
A randomized controlled trial comparing the subclavian and femoral insertion sites reports that the femoral site had a higher frequency of thrombotic complications in adult patients (Category A3 evidence ). A randomized controlled trial comparing the internal jugular insertion site with the femoral site reports equivocal findings for arterial puncture (P = 0.35), deep venous thrombosis (P = 0.62) or hematoma formation (P = 0.47) (Category C2 evidence ). A randomized controlled trial comparing the internal jugular insertion site with the subclavian site reports equivocal findings for successful venipuncture (P = 0.03) (Category C2 evidence ).Nonrandomized comparative studies report equivocal findings for arterial puncture, pneumothorax, hematoma, hemothorax, or arrhythmia when the internal jugular insertion site is compared with the subclavian insertion site (Category C3 evidence ).
Most consultants and ASA members indicate that the internal jugular insertion site is preferred to minimize catheter cannulation-related risk of injury or trauma. Most consultants and ASA members also indicate that the internal jugular insertion site is preferred to minimize catheter-related risk of thromboembolic injury or trauma.
Recommendations for Catheter Insertion Site Selection.
Catheter insertion site selection should be based on clinical need and practitioner judgment, experience, and skill. In adults, selection of an upper body insertion site should be considered to minimize the risk of thrombotic complications.