Site-specific complications of central venous catheterization under systematic ultrasound guidance: a target trial emulation revisiting the 3SITES study
Authors' conclusion
Assuming universal real-time ultrasound-guided central venous catheterization, subclavian access retains lower infectious and thrombotic risk without an observed increase in mechanical complications
Study context
- Population
- ICU central venous catheterizations from the 3SITES dataset
- Participants
- 3,409 catheters
- Comparison
- Femoral vs Internal jugular vs Subclavian
- Femoraln = 1,153
- Internal jugularn = 1,267
- Subclaviann = 989
- Primary endpoint
- Composite of:
- Time to catheter-related bloodstream infection
- Symptomatic deep-vein thrombosis
Methodological detailssecondary analysis of the 3SITES randomised trial dataset, inverse probability weighting, counterfactual framework assuming universal ultrasound guidance
- Secondary analysis of the 3SITES randomised trial dataset
- Inverse probability weighting
- Counterfactual framework assuming universal ultrasound guidance
Primary result
As reported in the abstract
- Subclavian vs Femoral: P = 0.02
- Subclavian vs Internal jugular: P = 0.001
- Internal jugular vs Femoral: P = 0.97
Secondary outcomes
| Outcome | P value |
|---|---|
| Catheter-related bloodstream infectionSubclavian vs Internal jugular · significantly fewer with subclavian | P = 0.001 |
Asymptomatic thrombosis
- More frequent at femoral and jugular sites
Safety
Major mechanical complications
- Rare and did not differ significantly across sites
Original publication
Site-specific complications of central venous catheterization under systematic ultrasound guidance: a target trial emulation revisiting the 3SITES study. Crit Care. Published 2 December 2025. doi:10.
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