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Tunneled Infusion Catheters: Increased Incidence of Symptomatic Venous Thrombosis after Subclavian versus Internal Jugular Venous Access¹

¹ From the Departments of Radiology (S.O.T., J.K.F., M.S.J., H.S.) and Medicine (W.T.A., P.H.K.), Indiana University School of Medicine, University Hospital, Rm 0279, 550 N University Blvd, Indianapolis, IN 46202-5253. Received November 17, 1999; revision requested December 30; revision received January 24, 2000; accepted February 22. Supported by a grant from Bard Access Systems. Address correspondence to S.O.T. (e-mail: streroto@iupui.edu).

PURPOSE: To compare the incidence of symptomatic venous thrombosis after tunneled infusion catheter placement via the internal jugular vein (IJV) versus the subclavian vein (SCV).

MATERIALS AND METHODS: A retrospective analysis was performed of 774 catheters placed. Only patients with complete follow-up were included, which yielded a population of 279 catheters in 238 patients (166 in the SCV, 113 in the IJV; total of 26,242 catheter days). All catheters were placed by interventional radiologists with ultrasonographic (in IJV) or venographic (in SCV) guidance.

RESULTS: Initial complications were limited to one pneumothorax in the SCV group and one episode of oversedation in the IJV group. There was no difference in infection rates between the two sites (SVC vs IJV: 0.25 vs 0.32 per 100 catheter days; P > .99). The mean dwell time was slightly longer for SCV catheters (103 days) than for IJV catheters (79 days) (P = .04). Venous thrombosis developed in 13% of patients (0.12 per 100 catheter days) with an SVC catheter placed as compared with in 3% (0.04 per 100 catheter days) with an IJV catheter (P = .018). This difference persisted after adjustment for catheter size and side of placement (P = .025). The mean time to thrombosis was 36 days for SCV catheters and 142 days for IJV catheters.

CONCLUSION: The IJV is the preferred site for tunneled infusion catheter placement because of the lower incidence of symptomatic venous thrombosis.

Index terms: Catheters and catheterization, complications, 907.442, 9462.442 • Veins, access, 907.1269, 9462.1269 • Veins, interventional procedures, 907.1269, 9462.1269 • Veins, thrombosis, 907.442, 9462.442

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