Central venous catheters (CVC) placed either via the internal jugular vein (IJV) or the subclavian vein (SCV) are routinely used in patients with hematologic malignancies. In this retrospective study, we systematically compared CVC-associated complications for both insertion sites, IJV and SCV. Between January 2011 and June 2013, all consecutive patients (n = 87) were included with at least one CVC (n = 153; n = 94 IJV; n = 59 SCV) at our institution due to induction/consolidation for AML/ALL or autologous hematopoietic cell transplantation (HCT). Primary study endpoints were central line-associated (CLABSI), catheter-related (CRBSI) blood stream infections and local inflammation (LI) at the insertion site. CRBSI occurred earlier and more frequently in the IJV- versus the SCV-group with an incidence rate of CRBSI at day 15 of 10% versus 0% (p = .04) and a rate of CRBSI per 1000 CVC days of 5.7 versus 1.2. In addition, CLABSI was detected more often in IJV- compared to SCV-CVC (26% vs. 8%, p = .009). Conversely, LI occurred more frequently and earlier in SCV- versus IJV-CVC (88% vs. 56%, p < .0001) with a median time to LI of 9 versus 14 days (p < .0001). The strongest risk factor for the endpoints CRBSI, CLABSI, and LI was the insertion site. However, SCV insertion was a risk factor for LI (p = .001, HR: 2.0), insertion in the IJV a risk factor for CLABSI (p = .044, HR: 2.7) and CRBSI (p = .036, HR: 5.4). These results demonstrate a differential effect of the insertion site of CVC in neutropenic patients with a significantly reduced frequency of CVC-related blood stream infections in SCV-CVC.

中文翻译：

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插入部位是血液系统恶性肿瘤患者中心静脉导管相关并发症的主要危险因素

通过颈内静脉 (IJV) 或锁骨下静脉 (SCV) 放置的中心静脉导管 (CVC) 通常用于血液系统恶性肿瘤患者。在这项回顾性研究中，我们系统地比较了插入部位 IJV 和 SCV 的 CVC 相关并发症。2011 年 1 月至 2013 年 6 月期间，所有连续患者 ( n  = 87) 均包含至少一个 CVC ( n  = 153；n  = 94 IJV；n = 59 SCV）在我们机构由于 AML/ALL 或自体造血细胞移植 (HCT) 的诱导/巩固。主要研究终点是插入部位的中心线相关 (CLABSI)、导管相关 (CRBSI) 血流感染和局部炎症 (LI)。IJV 组与 SCV 组相比，CRBSI 发生更早且更频繁，第 15 天的 CRBSI 发生率为 10% 与 0% ( p  = .04)，每 1000 个 CVC 天的 CRBSI 发生率为 5.7 与 1.2。此外，与 SCV-CVC 相比，CLABSI 在 IJV- 中的检测率更高（26% 对 8%，p  = .009）。相反，LI 在 SCV- 与 IJV-CVC 相比更频繁和更早发生（88% 与 56%，p  < .0001），至 LI 的中位时间为 9 天与 14 天（p < .0001)。终点 CRBSI、CLABSI 和 LI 的最强风险因素是插入部位。然而，SCV 插入是 LI（p  = .001，HR：2.0）的风险因素，IJV 插入是 CLABSI（p  = .044，HR：2.7）和 CRBSI（p  = .036，HR： 5.4)。这些结果表明 CVC 插入部位对中性粒细胞减少患者的不同影响，SCV-CVC 中 CVC 相关血流感染的频率显着降低。