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Comment & Response | Less Is More

Insertion Site for Central Venous Catheters

Kleper N. F. de Almeida, MD1
[+] Author Affiliations
1Comprehensive Infectious Diseases, Wellington, Florida
JAMA Intern Med. 2015;175(5):861. doi:10.1001/jamainternmed.2015.39.
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To the Editor I applaud the new series “Less Is More,” which highlights the concept of cost-conscious care in a concise, reader-friendly format.

In their article demonstrating the costs associated with central venous catheters (CVCs), Patel et al1 suggest that an internal jugular vein site decreases the risk of infection compared with a subclavian vein site. Recognizably, the data on catheter-related complications is plentiful but mostly not conclusive.2,3 Several confounders exist that confuse the picture and require that recommendations be made for specific scenarios (eg, medical vs surgical or trauma intensive care vs other hospitalized patients vs ambulatory patients; cancer vs noncancer patients; hemodialysis vs nonhemodialysis patients; implantable vs tunneled vs peripherally inserted catheters). In addition, the results might vary on the basis of different outcomes, ie, bloodstream infection, thrombosis, and venous stenosis.


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May 1, 2015
Leonard A. Mermel, DO, ScM; Jean-Jacques Parienti, MD, PhD
1Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island2Division of Infectious Diseases, Department of Epidemiology & Infection Control, Rhode Island Hospital, Providence
3Department of Biostatistics & Clinical Research, Côte de Nacre University Hospital Center, Caen, France4Risques Microbiens, Faculté de Médecine, Université de Caen Basse-Normandie, Caen, France
JAMA Intern Med. 2015;175(5):861-862. doi:10.1001/jamainternmed.2015.36.
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