What is the best central venous catheter insertion site in intensive care unit patients?
Although subclavian access is associated with fewer infectious complications, mechanical complications are common and can have serious consequences. When selecting the insertion site, the risk profile of the individual patient should be evaluated. Subclavian access is preferable when the risk for infection is high. Because the risk for infection increases with the duration of catheter use, the subclavian approach is probably the best choice if the patient is expected to require a catheter for 5 days or more. Because failure of the first attempt at subclavian catheter insertion dramatically increases the risk for mechanical complications [4], every effort should be made to increase the likelihood of a successful first attempt. The procedure should be performed with caution and by a trained operator. Real-time ultrasound guidance significantly decreased the risk for jugular and subclavian catheter placement failure (RR 0.32, 95% CI 0.18–0.55), for complications during catheter placement
