Researchers conducted a systematic review and meta-analysis of 130 observational and randomized studies spanning from 2015 to 2023 to estimate the complication rate associated with central venous catheters (CVCs) in adult inpatients. The study excluded peripherally inserted central venous catheters, dialysis catheters, long-term tunneled catheters, and catheters placed by radiologists.
The analysis revealed that the three most common complications related to CVC insertions were placement failure (20.4 events per 1000 catheters placed), arterial puncture (16.2 events per 1000 catheters placed), and pneumothorax (4.4 events per 1000 catheters placed). The composite outcome of four serious complications (arterial cannulation, pneumothorax, infection, and deep venous thrombosis) from a CVC placed for 3 days was estimated to occur at a rate of 30 events per 1000 catheters placed, translating to approximately 3%.
Additionally, the use of ultrasonography during insertion was associated with a fourfold reduction in the rate of immediate insertion complications (placement failure, arterial puncture, and pneumothorax) compared to procedures performed without ultrasonography guidance.
I always prefer subclavian if there’s no obvious contra-indication.