Where to Place a Central Line? Revisiting Site Choice in the Age of Ultrasound

Central venous catheters (CVCs), despite their inherent risks, are integral to managing critically ill patients. In a decade-old randomized trial (3SITES), CVCs placed in subclavian veins caused fewer bloodstream infections and deep venous thromboses (DVTs) but more mechanical complications (e.g., pneumothorax) than did those placed in the internal jugular or femoral veins. However, ultrasound guidance was employed in less than one third of cases, and in only 5% of subclavian lines.

Acknowledging the routine use of ultrasound guidance in today’s inpatient settings (see Figure 1), the 3SITES researchers revisited that study’s data using target-trial emulation methods — in essence, re-evaluating the ≈3400 catheter placements as if ultra…