Pilot Doc said:
Subclavian lines have the lowest infection rates. IJ and femoral, believe it or not, have identical infection rates. IJ is preferred because it doesn't increase DVT risk.
So I was wrong ... IJ is, if anythign, worse than femoral
CDC Guidelines
Site of Catheter Insertion
The site at which a catheter is placed influences the subsequent
risk for catheter-related infection and phlebitis. The
influence of site on the risk for catheter infections is related in
part to the risk for thrombophlebitis and density of local skin flora.
Phlebitis has long been recognized as a risk for infection.
For adults, lower extremity insertion sites are associated with
a higher risk for infection than are upper extremity sites
(4951). In addition, hand veins have a lower risk for phlebitis
than do veins on the wrist or upper arm (52).
The density of skin flora at the catheter insertion site is a
major risk factor for CRBSI. Authorities recommend that
CVCs be placed in a subclavian site instead of a jugular or
femoral site to reduce the risk for infection. No randomized
trial satisfactorily has compared infection rates for catheters
placed in jugular, subclavian, and femoral sites. Catheters inserted
into an internal jugular vein have been
associated with higher risk for infection than those inserted
into a subclavian or femoral vein (22,53,54).
Femoral catheters have been demonstrated to have relatively
high colonization rates when used in adults (55). Femoral catheters
should be avoided, when possible, because they are associated
with a higher risk for deep venous thrombosis than are
internal jugular or subclavian catheters (5660) and because
of a presumption that such catheters are more likely to
become infected. However, studies in pediatric patients have
demonstrated that femoral catheters have a low incidence of
mechanical complications and might have an equivalent
infection rate to that of nonfemoral catheters (6163). Thus,
in adult patients, a subclavian site is preferred for infection
control purposes, although other factors (e.g., the potential
for mechanical complications, risk for subclavian vein stenosis,
and catheter-operator skill) should be considered when
deciding where to place the catheter. In a meta-analysis of eight
studies, the use of bedside ultrasound for the placement
of CVCs substantially reduced mechanical complications
compared with the standard landmark placement technique
(relative risk [RR] = 0.22; 95% confidence interval
[CI] = 0.100.45) (64). Consideration of comfort, security,
and maintenance of asepsis as well as patient-specific factors
(e.g., preexisting catheters, anatomic deformity, and bleeding
diathesis), relative risk of mechanical complications (e.g., bleeding
and pneumothorax), the availability of bedside ultrasound,
and the risk for infection should guide site selection.
