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Abstract

Introduction: Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may result in severe complications including infection, deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. We hypothesized that femoral trauma resuscitation CVCs are safer than subclavian trauma resuscitation CVCs. Our primary study objective was to compare life-threatening complications secondary to subclavian versus femoral CVC placement during initial trauma resuscitations. Methods: A retrospective review (2010–2011) at an urban, Level-I Trauma Center revealed 504 subclavian or femoral CVCs placed during initial trauma resuscitations. Demographics and clinical characteristics were analyzed. Measured complications included catheter related DVTs and arterial injuries, along with life-threatening complications including catheter related bloodstream infections, pneumothoraces and PEs. Fisher’s exact test and Student’s t-test compared categorical and continuous variables. A p≤ 0.05 was statistically significant. Results: Overall, 504 CVCs were placed (subclavian, n=259; femoral, n=245). No difference in age (47 ± 22 vs. 45 ± 23 years) or BMI (28 ± 6 vs. 29 ± 16 kg/m2) was detected (p>0.05) in patients who underwent subclavian vs. femoral CVC placement, but those who underwent subclavian CVC placement more often had blunt injuries (81% vs. 69%), had a greater SBP (95 ± 55 vs. 83 ± 43 mmHg) and GCS (10 ± 5 vs. 9 ± 5), and were less likely to have introducer catheters placed (49% vs. 73%) than those with femoral CVC insertion (all p<0.05). While no difference in total attributable complications was detected between subclavian and femoral CVC groups (p=0.184), complications were more often life-threatening in the subclavian (61%) rather than the femoral CVC group (24%, p=0.005). Conclusions: Both subclavian and femoral CVCs were associated with significant complication rates, but attributable life-threatening complications were more common after subclavian CVC placement. Our results suggest that femoral CVC insertion is safer than subclavian CVC insertion during initial trauma resuscitations. Thus, femoral CVC access should be the anatomic site of choice in this clinical scenario.