***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVES Several temporary venous catheterizations are sometimes required for acute renal replacement therapy ( RRT ) in the intensive care unit ( ICU ) . This study compares first and second catheterizations in the femoral and jugular veins in terms of patient safety . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS A crossover study from the catheter-dialysis r and omized study ( Cathedia ) , which was conducted among 736 critically ill adults requiring RRT , was performed . Catheter insertion complications , catheter-tip colonization , catheter dysfunction and urea reduction ratio ( URR ) were analyzed considering the crossover and longitudinal design s. RESULTS This study analyzed 134 patients who underwent two different sites of catheterization , 57 and 77 of whom were initially r and omized in the femoral and jugular site , respectively . Using anatomic l and marks , time to insert a femoral catheter  was shorter ( P=0.01 ) and more successful ( P=0.003 ) compared with catheterization in the jugular site . Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion ( median , 14 days in both groups ; hazard ratio , 0.99 ; 95 % confidence interval , 0.61 - 1.59 ; P=0.96 ) , as well as time to dysfunction . URRs were analyzed from 395 dialysis sessions ( n=48 patients ) . No significant difference ( P=0.49 ) in mean URR was detected between sessions performed through femoral ( n=213 ; 50.9 % ) and jugular ( n=182 ; 49.5 % ) dialysis catheters . CONCLUSIONS These results vali date prior results of this study group and extend external validity to the second catheter used for RRT in the ICU . Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU BACKGROUND Intravascular-catheter-related infections are frequent life-threatening events in health care , but incidence can be decreased by improvements in the quality of care . Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections . We hypothesised that chlorhexidine-alcohol would be more effective than povidone iodine-alcohol as a skin antiseptic to prevent intravascular-catheter-related infections . METHODS In this open-label , r and omised controlled trial with a two-by-two factorial design , we enrolled consecutive adults ( age ≥18 years ) admitted to one of 11 French intensive-care units and requiring at least one of central -venous , haemodialysis , or arterial catheters . Before catheter insertion , we r and omly assigned ( 1:1:1:1 ) patients via a secure web-based r and om-number generator ( permuted blocks of eight , stratified by centre ) to have all intravascular catheters prepared with 2 % chlorhexidine-70 % isopropyl alcohol ( chlorhexidine-alcohol ) or 5 % povidone iodine-69 % ethanol ( povidone iodine-alcohol ) , with or without scrubbing of the skin with detergent before antiseptic application . Physicians and nurses were not masked to group assignment but microbiologists and outcome assessors were . The primary outcome was the incidence of catheter-related infections  with chlorhexidine-alcohol versus povidone iodine-alcohol in the intention-to-treat population . This study is registered with Clinical Trials.gov , number NCT01629550 and is closed to new participants . FINDINGS Between Oct 26 , 2012 , and Feb 12 , 2014 , 2546 patients were eligible to participate in the study . We r and omly assigned 1181 patients ( 2547 catheters ) to chlorhexidine-alcohol ( 594 patients with scrubbing , 587 without ) and 1168 ( 2612 catheters ) to povidone iodine-alcohol ( 580 patients with scrubbing , 588 without ) . Chlorhexidine-alcohol was associated with lower incidence of catheter-related infections ( 0·28 vs 1·77 per 1000 catheter-days with povidone iodine-alcohol ; hazard ratio 0·15 , 95 % CI 0·05 - 0·41 ; p=0·0002 ) . Scrubbing was not associated with a significant difference in catheter colonisation ( p=0·3877 ) . No systemic adverse events were reported , but severe skin reactions occurred more frequently in those assigned to chlorhexidine-alcohol ( 27 [ 3 % ] patients vs seven [ 1 % ] with povidone iodine-alcohol ; p=0·0017 ) and led to chlorhexidine discontinuation in two patients . INTERPRETATION For skin antisepsis , chlorhexidine-alcohol provides greater protection against short-term catheter-related infections than does povidone iodine-alcohol and should be included in all bundles for prevention of intravascular catheter-related infections . FUNDING University Hospital of Poitiers , CareFusion The low-flow method has been shown as a reliable evaluation of access recirculation . Few data is available on temporary central catheter blood recirculation ; results of 2 % and 4 % have been reported in subclavian , 10 % in 24 cm long femoral , and 18 % in 15 cm long femoral catheters , mostly in indwelling catheters for chronic hemodialysis . The purpose of this prospect i ve study was to evaluate blood recirculation in a larger number of recently inserted temporary intravenous catheters for acute hemodialysis , comparing subclavian and femoral sites . Fifty blood recirculation measurements were performed in 38 different temporary central venous dialysis catheters inserted in thirty-one critically ill patients from medical and surgical intensive care units presenting acute renal failure supported by intermittent hemodialysis . All the catheters used were well-functioning 11.5 French dual lumen Quinton of 13.5 or 19.5 cm length . Catheters presenting mechanical dysfunction , which did not allow a blood flow rate of 300 ml/min or for which lines had to be reversed were excluded from the analysis . Access blood recirculation was measured shortly after catheter insertion according to the low flow method applied after the first 30 minutes of hemodialysis at a blood flow rate of 300 ml/min . Mean blood recirculation for the 50 measurements was 10.3 + /- 9.2 % . It was significantly higher in the 26 femoral catheters than in the 24 subclavian catheters , reaching respective means of 16.1 + /- 9.1 % and 4.1 + /- 3.6 % ( p = 0.0001 ) . Blood recirculation rate was not different between 13.5 cm and 19.5 cm long subclavian catheters ( 3.0 + /- 2.6 % , n = 13 , versus 5.4 + /- 4.3 % , n = 11 , respectively ) , but was significantly higher in 13.5 cm long femoral catheters ( 22.8 + /- 9.1 % , n = 9 , versus 12.6 + /- 6.9 % , n = 17 ) ( p = 0.004 ) . Blood recirculation was measured on two separate occasions in 12 catheters r and omly selected ( 5 femoral and 7 subclavian catheters ) ; the obtained results were reproducible with a mean difference of only 2.1 + /- 1.8 % between the two measurements and a correlation of 0.96 . The mean time elapsed between catheter insertion and recirculation assessment was 2.2 + /- 3.1 days and was similar for femoral and subclavian catheters . No correlation was found between the percentage of recirculation and the arterial and venous resistances recorded during dialysis session or with the time from catheter insertion . Mean urea reduction ratio ( URR ) for the 50 dialysis sessions was 57.8 + /- 13.0 % . It was significantly higher for sessions performed with subclavian than with femoral catheters ( 62.5 + /- 10.9 % , n = 24 , versus 54.5 + /- 14.2 % , n = 26 ) ( p = 0.03 ) . In conclusion , the expected blood recirculation in well-functioning and recently  inserted temporary dialysis catheters is under 5 % for subclavian , over 12 % in 19.5 cm femoral , and over 22 % in shorter 13.5 cm femoral catheters at a blood flow rate of 300 ml/min . The consequently reduced dialysis efficiency with femoral catheters is another factor to be considered in the choice of a site for temporary dialysis catheter insertion in acute renal failure patients , particularly when dialysis dose delivery is a priority , such as intoxication cases treated by extracorporeal therapy Background Intensive care unit ( ICU ) patients require dialysis catheters ( DCs ) for renal replacement therapy ( RRT ) . They carry a high risk of developing end-stage renal disease , and therefore their vascular access must be preserved . Guidewire exchange ( GWE ) is often used to avoid venipuncture insertion ( VPI ) at a new site . However , the impact of GWE on infection and dysfunction of DCs in the ICU is unknown . Our aim was to compare the effect of GWE and VPI on DC colonization and dysfunction in ICU patients . Methods Using data from the ELVIS r and omized controlled trial ( RCT ) ( 1496 ICU adults requiring DC for RRT or plasma exchange ) we performed a matched-cohort analysis . Cases were DCs inserted by GWE ( n = 178 ) . They were matched with DCs inserted by VPI . Matching criteria were participating centre , simplified acute physiology score ( SAPS ) II + /-10 , insertion site ( jugular or femoral ) , side for jugular site , and length of ICU stay before DC placement . We used a marginal Cox model to estimate the effect of DC insertion ( GWE vs. VPI ) on DC colonization and dysfunction . Results DC colonization rate was not different between GWE-DCs and VPI-DCs ( 10 ( 5.6 % ) for both groups ) but DC dysfunction was more frequent with GWE-DCs ( 67 ( 37.6 % ) vs. 28 ( 15.7 % ) ; hazard ratio ( HR ) , 3.67 ( 2.07–6.49 ) ; p < 0.01 ) . Results were similar if analysis was restricted to DCs changed for dysfunction . Conclusions GWE for DCs in ICU patients , compared with VPI did not contribute to DC colonization or infection but was associated with more than twofold increase in DC dysfunction . Trial registration This study is registered with Clinical Trials.gov , number NCT00563342 . Registered 2 April 2009 Aims : The study aims to describe the use of  dialysis catheters in critically ill patients treated with continuous renal replacement therapy ( CRRT )  and to study the impact of femoral versus non-femoral access on CRRT dose . Methods : Statistical analysis and predictive modelling of data from the R and omized Evaluation of Normal vs. Augmented Level renal replacement therapy trial . Results : The femoral vein was the first access site in 937 ( 67 % ) of 1,399 patients . These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores ( p = 0.009 ) and lower pH ( p < 0.001 ) but similar mortality to patients with non-femoral access  ( 44 vs. 45 % ; p = 0.63 ) . Lower body weight was independently associated with femoral access placement ( OR 0.97 , 95 % CI 0.96 - 0.98 ) . Femoral access was associated with a 1.03 % lower CRRT dose ( p = 0.05 ) , but a 4.20 % higher dose was achieved with 13.5 Fr catheters ( p = 0.03 ) . Conclusions : Femoral access was preferred in lighter and sicker patients . Catheter gauge had greater impact than catheter site in CRRT dose delivery . Video Journal Club “ Cappuccino with Claudio Ronco ” at http://www.karger.com/?doi=439581 From January 1986 to December 1990 we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subclavian catheter for 50 ( first group ) and by internal jugular catheter for the 50 others ( second group ) . These two groups were not statistically different as regards age ( 61.6 + /- 11.3 years in the first and 61 + /- 11.1 in the second ) , sex ( 48 % and 56 % were women ) ,  duration of catheter insertion ( 31 + /- 21.8 and 31.7 + /- 16 days ) , and the number of dialysis sessions ( 13.5 + /- 9.1 and 13.6 + /- 7.1 ) . The type of catheters , the frequency 
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A diferencia de la terapia de reemplazo renal para pacientes con enfermedad renal crónica donde la fístula arteriovenosa es la primera opción , seguida del catéter tunelizado , en pacientes con lesión renal aguda el acceso vascular de elección es el catéter temporal .
En pacientes que cuentan con fístula arteriovenosa preexistente , su punción en pacientes con inestabilidad hemodinámica conlleva riesgos y no puede ser recomendada .
The length of the access should be evaluated according to the insertion site , while 20 cm catheters are usually suitable for right jugular puncture , the left jugular usually requires 25 cm for achieving the position inside the right atrium .
On the other h and , the femoral access increases its performance with lengths of 25 - 35 cm .
The low posterior jugular approach is considered a simple , safe technique that allows up to 5 cm further towards the right atrium .
The use of heparin 1000 U/ml for sealing the ports reduces the risk of bleeding compared to heparin 5000 U/ml .