Femoral versus Intrajugular Dialysis Catheters: the Debate Continues

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A recent JAMA article (Parienti et al, JAMA 2008) was presented in journal club today which involved a randomized control trial looking at infectious and other complications seen in patients with acute kidney injury in an ICU who were randomized to receive dialysis via either (a) a femoral catheter, or (b) an intrajugular catheter.

Traditionally, I have always been taught to do an intrajugular catheter if at all possible given the additional infectious risks associated with long-term femoral catheters. Indeed, the KDOQI Guidelines state that temporary femoral catheters should be left in for only 5 days whereas temporary IJ catheters may be left in for up to 3 weeks. Interestingly, however, the study found no significant differences in infection (as assessed by catheter tip culture growth) between the two groups!

The study did find that patients who are more obese (BMI >28) have a greater infectious risk with femoral compared to IJ catheters. What was more suprising, however, was their finding that patients in the “low BMI” group (BMI

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