{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:03:15Z","timestamp":1790359395441,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T00:00:00Z","timestamp":1383264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>When subclavian access is not possible, controversy exists between the internal jugular and femoral sites for the choice of central-venous access in intensive care unit patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare infection and colonization rates of short-term jugular and femoral catheters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from two multicenter studies, we compared femoral and internal jugular for the risks of catheter-related bloodstream infection, major catheter-related infection, and catheter-tip colonization. We also compared the rates of dressing disruption and skin colonization. We used marginal structural models with inverse probability of treatment weighting to adjust on indication bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>We included 2,128 patients (2,527 catheters and 19,481 catheter-days). We found no difference in catheter-related bloodstream infection (internal jugular 1.0 vs. femoral 1.1 per 1,000 catheter-days; hazard ratio [HR], 0.63 [0.25\u20131.63]; P = 0.34), major catheter-related infection (internal jugular 1.8 vs. femoral 1.4 per 1,000 catheter-days; HR, 0.91 [0.38\u20132.18]; P = 0.34), and colonization (internal jugular 11.6 vs. femoral 12.9 per 1,000 catheter-days; HR, 0.80 [0.25\u20131.63]; P = 0.15). However, colonization was higher with femoral for female (HR, 0.39 [0.24\u20130.63]; P &amp;lt; 0.001) and, at the significance limit, catheter maintained for more than 4 days (HR, 0.73 [0.53\u20131.01]; P = 0.05). The absence of benefit of internal jugular before Day 5 was related to a higher skin colonization at the internal jugular site for catheters removed before Day 5. After the fourth day, dressing disruption became more frequent with femoral catheters and may explain the subsequent risk of catheter colonization. Differences in cutaneous and catheter colonization between internal jugular and femoral was suppressed by the use of chlorhexidine-impregnated dressings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Femoral and internal jugular accesses lead to similar risks of catheter infection. Internal jugular might be preferred for female, nonchlorhexidine-impregnated dressings users, and when catheters are left in place more than 4 days. Both sites are acceptable when a subclavian approach is not feasible.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT00417235 and NCT01189682).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201303-0460oc","type":"journal-article","created":{"date-parts":[[2013,10,15]],"date-time":"2013-10-15T23:16:39Z","timestamp":1381878999000},"page":"1232-1239","source":"Crossref","is-referenced-by-count":64,"title":["Jugular versus Femoral Short-Term Catheterization and Risk of Infection in Intensive Care Unit Patients. Causal Analysis of Two Randomized Trials"],"prefix":"10.1093","volume":"188","author":[{"given":"Jean-Fran\u00e7ois","family":"Timsit","sequence":"first","affiliation":[{"name":"Grenoble 1 (Joseph Fourier) University, U823 \u201cOutcome of Cancers and Critical Illness,\u201d Albert Bonniot Institute, La Tronche, France"},{"name":"Medical ICU and"},{"name":"Paris-Descartes, Medical ICU, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila","family":"Bouadma","sequence":"additional","affiliation":[{"name":"Paris-Descartes, Medical ICU, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Mimoz","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, Poitiers University Hospital, Poitiers University and Inserm U1070, Poitiers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Jacques","family":"Parienti","sequence":"additional","affiliation":[{"name":"Biostatistics and Clinical Research Unit, CHU Caen, Caen University, Caen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u00eft\u00e9","family":"Garrouste-Orgeas","sequence":"additional","affiliation":[{"name":"Grenoble 1 (Joseph Fourier) University, U823 \u201cOutcome of Cancers and Critical Illness,\u201d Albert Bonniot Institute, La Tronche, France"},{"name":"Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge","family":"Alfandari","sequence":"additional","affiliation":[{"name":"Intensive Care and Infectious Diseases Unit, General Hospital, Tourcoing, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga\u00e9tan","family":"Plantefeve","sequence":"additional","affiliation":[{"name":"Medical Surgical ICU, General Hospital, Argenteuil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9gis","family":"Bronchard","sequence":"additional","affiliation":[{"name":"Surgical ICU, Bichat-Claude Bernard University Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Troche","sequence":"additional","affiliation":[{"name":"Medical Surgical Intensive Care Unit, General Hospital, Versailles, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remy","family":"Gauzit","sequence":"additional","affiliation":[{"name":"Surgical Intensive Care Unit, Hotel-Dieu University Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Antona","sequence":"additional","affiliation":[{"name":"General ICU, Raymond Poincar\u00e9 Hospital (APHP), University of Versailles SQY, Garches, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Canet","sequence":"additional","affiliation":[{"name":"Paris VII University, Medical ICU, Saint Louis Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Bohe","sequence":"additional","affiliation":[{"name":"Claude-Bernard Lyon 1 University, Medical-Surgical ICU, Lyon Sud Hospital, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Herrault","sequence":"additional","affiliation":[{"name":"Surgical ICU, Grenoble 1 University, Albert Michallon Hospital, Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Schwebel","sequence":"additional","affiliation":[{"name":"Medical ICU and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Ruckly","sequence":"additional","affiliation":[{"name":"Grenoble 1 (Joseph Fourier) University, U823 \u201cOutcome of Cancers and Critical Illness,\u201d Albert Bonniot Institute, La Tronche, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Souweine","sequence":"additional","affiliation":[{"name":"Clermont-Ferrand University, Medical ICU, Gabriel Montpied Hospital, Clermont-Ferrand, France; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Lucet","sequence":"additional","affiliation":[{"name":"Infection Control Unit, Bichat-Claude Bernard University Hospital, Assistance-Publique H\u00f4pitaux de Paris, and Paris Diderot University, Sorbonne Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2013,11,15]]},"reference":[{"key":"2026032100431292100_bib1","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.1093\/cid\/cir257","article-title":"Guidelines for the prevention of intravascular catheter-related infections","volume":"52","author":"O'Grady","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026032100431292100_bib2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/s-0031-1275526","article-title":"New challenges in the diagnosis, management, and prevention of central venous catheter-related infections","volume":"32","author":"Timsit","year":"2011","journal-title":"Semin Respir Crit Care Med"},{"key":"2026032100431292100_bib3","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/cid\/ciq108","article-title":"What is the predominant source of intravascular catheter infections?","volume":"52","author":"Mermel","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026032100431292100_bib4","first-page":"253","article-title":"Risk factors for central venous catheter-related infections in surgical and intensive care units. 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