Sir: Although many studies have reported a higher incidence of catheter-related infection in internal jugular than subclavian access, we have no found study describing the internal jugular access used (posterior, central, or anterior) [1–4]. In addition, we have recently published results of a study showing a higher incidence of central venous catheter related bacteremia (CVC-RB) using central than the posterior internal jugular venous access [5]. The objective of this study was to determine the effect of posterior internal jugular or subclavian venous accesses on the incidence of CVC-RB.

We analyzed patients admitted to the polyvalent medical-surgical intensive care unit (ICU) of the Hospital Universitario de Canarias (Tenerife, Spain) between 1 May 2000 and 30 April 2004 who were undergoing posterior internal jugular or subclavian venous catheterization. CVC-RB was defined according to the following criteria: positive blood culture obtained from a peripheral vein (two positive blood cultures for coagulase negative staphylococci), signs of systemic infection (fever, chills, and/or hypotension), no apparent source of bacteremia except the central venous catheter, and catheter-tip colonization (growth of a micro-organism > 15 colony-forming units) with the same organism than in blood culture. Continuous variables are expressed as mean and standard deviation, and the comparisons were carried out with the Kruskall–Wallis test. Categorical variables are expressed as frequencies and percentages and were compared using the χ2 test. CVC-RB incidence per 1,000 catheter-days was compared using Poisson regression. A p-value less than 0.05 was considered statistically significant.

As shown in Table 1, we found no differences in baseline characteristics between the 877 subclavian and 169 posterior internal jugular venous accesses. Although the duration with the index catheter was lower in the subclavian venous accesses, Poisson regression analysis showed no found differences in the incidence of CVC-RB per 1,000 catheter-day. CVC-RBs were due to eight cases of Staphylococcus epidermidis and two of S. aureus.

Table 1 Characteristics of subclavian and posterior jugular catheters (CVC-RB, central venous catheter-related bacteremia; APACHE, Acute Physiology and Chronic Health Evaluation)
Full size table

In previous studies we found that the internal jugular (including central and posterior accesses) was associated with a higher incidence of catheter-related infection than subclavian venous access [3, 4]. We have since reported a higher incidence of CVC-RB using the central than the posterior internal jugular venous catheter [5], probably as the result of higher contamination by oropharyngeal secretion with the central access. Therefore patients in critical condition are placed in semirecumbent position to avoid ventilator-associated pneumonia. Our current study revealed no found differences in the incidence of CVC-RB between posterior internal jugular and subclavian access, possibly due to the lack of difference in the contamination by oropharyngeal secretion between the two access routes. The main limitations of this study were (a) that the central venous access routes were not randomly assigned, and (b) that the duration with index catheter was higher in the posterior internal jugular than in the subclavian venous access. Nevertheless we found no differences in the incidence of CVC-RB per 1,000 catheter-days using Poisson regression.

In conclusion, posterior internal jugular access could be can as safe as subclavian access to minimize the risk of CVC-RB.