| Kanter RK et al, 1986, USA, | Phase 1: threeyear surveillance in paediatric ICU of 161 catheters (49 femoral) (one third of children under 10 kg) Phase 2: 29 paediatric patients needing central line had femoral line 77% had Ultrasound evaluation for thrombus | Cohort study | Phase 1 complications | Femoral line: 6.1% complication rate including three leg swellings Neck sites: 4.5% complication rate, including two arm swellings | Poor gold standard for excluding thrombus as no children received ultrasound scanning or other imaging to look for thrombus, even if their leg swelled |
| | Phase 2 complications | Leg swelling in four patients and one thrombus around catheter at necropsy (11% adverse incident rate) | Also 14% arterial puncture rate |
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| Trottier SJ et al, 1995, | 45 patients in a medical and surgical ICU | PRCT | Thrombotic complications | Upper access sites: 0 of 21 positive ultrasound findings | The USS examination did not look at the upper extremity deep veins |
| Randomised to upper or lower central line placement Ultrasonography performed before insertion, after removal and 7 days after removal | | | Femoral access sites: 6 of 25 had DVT clinically and an additional 7 of 25 had USS findings of thrombosis | There were seven more triple lumen catheters inserted into the femoral vein than single lumen catheters, compared with upper access sites |
| Shefler A et al, 1995, Australia | 56 femoral lines in 54 children in a general paediatric ICU. Mean age 36 months range 0–192 months All patients had USS examination within three days of insertion and repeated every two to four days | Prospective cohort study | Thrombotic complications | IVC thrombosis was found in 6 of 56 children (10.6%). All six were found on, or after 8 days of insertion. Thromboses found on day: 8, 8, 10, 20, and 20. Only one patient showed clinical signs | Small uncontrolled cohort No attempt to look at USS of lower limb deep veins May not be applicable to adult or older child groups |
| Durbec O et al, 1997, France | 80 consecutive patients undergoing femoral central line in a single adult ICU | Observational cohort study | Thrombotic complications | No clinical signs of DVTs or PEs seen, but on phlebography 34% of patients had DVT and 25% popliteal thrombosis | No power study performed.Uncontrolled study |
| Durbec O et al, 1997, France | 61 ICU patients undergoing either femoral venous catheterisation (31) or internal jugular (10) or axillary vein (21) cannulation | PRCT | Thrombotic complications Phlebography | No patient had clinical signs of a DVT or PE Fibrin sleeve seen in 23% of femoral group and none in SVC group. Two femoral vein thromboses seen in femoral group and one femoral vein thrombosis in the SVC cannula group | Axillary vein cannulation is an atypical site to use as a control group |
| Bilateral leg phlebography performed on removal | | | No power calculations, underpowered study |
| Timsit JF et al, 1999, France | 336 patients in three intensive care units | PRCT | Time for insertion | 15 min for non-tunnelled line and 25 min for tunnelled line | 92% were ventilated |
| Randomly assigned to tunnelled or non-tunnelled femoral venous catheter | | Thrombotic complications | 7 DVTs | |
| 10 cm tunnel was used | | | | |
| Joynt GM et al, 2000, Hong Kong | 140 patients in an intensive care unit, all receiving a femoral line Duplex ultrasound performed before insertion, 12 hours after insertion, and then daily until removal | Cohort study | Thrombotic complications | 12 iliofemoral DVTs found in cannulated leg 2 found in uncannulated leg Positive findings were not related to coagulation status, attempts at insertion, duration of catheterisation, or heparin bonded line use | No control group to compare the types of complication found with subclavian line, for example, pneumothorax, but otherwise a well conducted study |
| Merrer J et al, 2001, France | 289 adult patients in eight intensive care units receiving first central line Randomly assigned to femoral insertion (n = 145) or subclavian insertion (n = 144) | PRCT | Thrombotic complications | USS detected Femoral 21.5% Subclavian 1.9%, p<0.01 Major thrombosis: femoral 6% subclavian 0% | Thrombotic complications only assessed in 76% of patients, (but reasons for all of these were accounted for) Otherwise well conducted study |