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February 2016 Central Line Placement: Location, Risk, Benefits & Evidence 

Some of our Attendings' were in an incredibly generous mood and elected to offer their time as presenters so our residents could have more time preparing for their in-service exam. This month's articles look at the topic of central line placement. Questions to be addressed include, best location for outcomes such as infection, thrombosis and stenoses. We will review a recent NEJM multi-centered RCT, a Cochrane Collaboration systematic review from 2012 and a systematic review and meta-analysis from two of EVMS's own clinicians. A few great video's have been posted by EmCrit and also a podcast with Dr. Marik. The topic should provide an opportunity to review the most current data, consider the expertise of our clinicians and their biases and how patient preferences may play into technique selection.  I anticipate the issue of ultrasound guided vs. landmark techniques will also come up when we consider the inter-generational knowledge gaps between the ultrasound savvy and those with extensive experience with landmark based subclavian lines who fear many are leaving residency without having high clinical confidence in non-ultrasound assisted central line techniques. Should make for an interesting JC. 

 Parenti JJ et al. Intravascular Complications of Central Venous Catherization by Insertion Site. N Engl J Med. 2015 Sep 24; 373(13): 1220-9

Ge X et al, Central venous access sites for the prevention of venous thrombosis, stenosis and infection      Cochrane Database Syst Rev. 2012 March 14;3

Marik PE, Flemmer M, The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med 2012 Aug 40(8):2479-85 Crit Care Med 2012 Aug;40(8):2479-85