***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: INTRODUCTION AND AIMS The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons . Alternative setting s for the introduction of totally implantable venous access devices ( TIVAD ) and the search for lower rates of morbidity led to the choice of other central veins . This study compares two different venous accesses , the subclavian ( SC ) versus the internal jugular ( IJ ) , in terms of early and late morbidity . PATIENTS AND METHODS This is a prospect i ve , non-r and omized , observational , uni-institutional ( tertiary cancer centre ) study . From March 2003 to March 2006 , 1231 TIVADs were placed ( 1201 patients ) , in an ambulatory operating room , under vital signs and EKG monitoring , using local anaesthesia and without perioperative radiological control . RESULTS Of the 1231 TIVAD , 617 were inserted via the SC and 614 via the IJ vein . The two groups ( SC vs. IJ ) were comparable as to general patient characteristics . Immediate complications were more frequent in the SC than in the IJ approach ( respectively , 5.0 % vs. 1.5 % ; p<0.001 ) ; Catheter malposition occurred in 2.3 % when using the SC vein and in 0.2 % for the IJ ( p=0.001 ) . Long term morbidity was also more frequent in the SC than in the IJ group ( respectively , 15.8 % , 87/551 , vs. 7.6 % , 39/512 ; p<0.001 ) . Venous thrombosis developed in 2.0 % of patients with an SC TIVAD as compared to 0.6 % with an IJ TIVAD ( p=0.044 ) . Catheter malfunction was significantly dependent on the vein used : SC - 9.4 % vs. IJ - 4.3 % ( p=0.001 ) . CONCLUSIONS Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD Fifty-seven patients developed an episode of catheter-related infection ( CRI ) in the bloodstream during their stay in the intensive care unit ( cases ) and were prospect ively observed to establish the attributable mortality , increase in length of stay , and excess costs . Costs were estimated by multiplying the number of excess days of stay by the reimbursement provided . The outcomes for these cases were compared with those for matched control subjects without CRI . Eight cases were excluded as no control was found . Of the 49 cases , 31 were coagulase-negative staphylococci ( CNS ) . The level of severity was similar for both groups ( APACHE II 15.5 + /- 7 . 2 versus 15.2 + /- 7.3 ) . There were no significant differences ( p > 0 . 20 ) in the mortality observed in the hospital for the cases ( 22.4 % , 95 % confidence interval [ CI ] 0.3 % to 34.9 % ) and the control subjects ( 34.7 % , 95 % CI 21.2 % to 40.1 % ) . Among the survivors , the hospital stay was increased by 19.6 d ( 95 % CI -1.1 ; 40.4 ) . This represents an added cost of 3,124 Euros per episode of CRI among the survivors . In conclusion , our cohort study failed to show a difference in attributable mortality due to CRI in intensive care unit patients . Nevertheless , these infections lead to an increase in hospital stay of approximately 20 d. Each episode of CRI represents an additional cost of more than 3,000 Euros BACKGROUND Little is known about vascular access infections in patients with acute renal failure . METHODS We prospect ively compared infection rates of  dialysis catheters ( DCs ) and central venous catheters ( CVCs ) in patients in the intensive care unit treated with renal replacement therapy for acute renal failure . The same insertion and maintenance procedures were used for CVCs and DCs . To circumvent the allocation bias caused by severity of patient condition , only patients with both types of catheters were included . RESULTS A total of 150 CVCs and 130 DCs were analyzed in 99 patients with a mean Simplified Acute Physiology Score II of 67 + /- 21 . The major cause of acute renal failure was sepsis ( 62 % ) . Hospital mortality was 62 % . Mean catheter duration was shorter for DCs ( 6.7 + /- 4.4 days ) than CVCs ( 7.8 + /- 4.9 days ; P = 0.03 ) . There was no difference between CVCs and DCs in cumulative incidence of catheter colonization ( quantitative catheter cultures > or = 10(3 ) colony-forming units/mL ; 4.7 % versus 6.2 % ; P = 0.58 ) or incidence density of catheter colonization per 1,000 catheter days ( 5.9 versus 9.1 ; P = 0.44 , respectively ) . There also was no difference between CVCs and DCs in cumulative incidence and incidence density regardless of whether catheters were placed at the internal jugular ( P = 0.34 and P = 0.23 ) or femoral site ( P = 0.57 and P = 0.80 ) , respectively . Three cases of CVC-related bacteremia ( the same microorganism responsible for both catheter colonization and blood culture result ) were recorded , but none with DC use . CONCLUSION When severity of patient condition is controlled for , epidemiological characteristics of colonization in CVCs and DCs are similar if similar infection control measures are used for insertion and maintenance The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein ( IJV ) versus the subclavian vein ( SV ) among 45 consecutive patients undergoing orthotopic liver transplantation ( OLT ) between January 2000 and June 2004 . The subjects were divided into two groups according to the site of central venous catheterization ( IJV or SV ) . We recorded each patient 's physical characteristics , international normalized ratio ( INR ) , partial thromboplastin time , platelet levels , number of puncture attempts , success/failure of central venous catheterization , duration of catheter placement , occurrence of catheter tip misplacement , arterial puncture , incidence of hematoma or pneumothorax , catheter-related infection , or bacterial colonization of the catheter . Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures . The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization . There were no significant differences between the groups with respect to success of central venous catheterization ( 100 % for both ) , numbers of attempted punctures , duration of catheter placement , and incidence rates of mechanical and infectious complications . Both groups showed high frequencies of catheter tip misplacement , with right atrium as the site of misplacement in all cases . Two patients in the IJV group ( 8.7 % ) developed hematomas after accidental carotid artery puncture . The results suggest that , when performed by experienced anesthesiologists , central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT BACKGROUND Central venous access is extensively used in oncology , though practical information from r and omized trials on the most convenient insertion modality and site is unavailable . METHODS Four hundred and three patients eligible for receiving i.v . chemotherapy for solid tumors were r and omly assigned to implantation of a single type of port ( Bard Port , Bard Inc. , Salt Lake City , UT ) , through a percutaneous l and mark access to the internal jugular , a ultrasound (US)-guided access to the subclavian or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove . Early and late complications were prospect ively recorded until removal of the device , patient 's death or ending of the study . RESULTS Four hundred and one patients ( 99.9 % ) were assessable : 132 with the internal jugular , 136 with the subclavian and 133 with the cephalic vein access . The median follow-up was 356.5 days ( range 0 - 1087 ) . No differences were found for early complication rate in the three groups { internal jugular : 0 % [ 95 % confidence interval ( CI ) 0.0 % to 2.7 % ] , subclavian : 0 % ( 95 % CI 0.0 % to 2.7 % ) , cephalic : 1.5 % ( 95 % CI 0.1 % to 5.3%)}. US-guided subclavian insertion site had significantly lower failures ( e.g. failed attempts to place the catheter in agreement with the original arm of r and omization , P = 0.001 ) . Infections occurred in one , three and one patients ( internal jugular , subclavian and cephalic access , respectively , P = 0.464 ) , whereas venous thrombosis was observed in 15 , 8 and 11 patients ( P = 0.272 ) . CONCLUSIONS Central venous insertion modality and sites had no impact on either early or late complication rates , but US-guided subclavian insertion showed the lowest proportion of failures OBJECTIVE To determine the frequency of central venous catheter-induced  deep vein thrombosis of the femoral vein . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Tertiary care center . PATIENTS Forty-five patients in a medical-surgical intensive care unit who required central venous catheterization .  INTERVENTIONS Patients were r and omized to receive central venous catheterization in either upper ( subclavian or internal jugular veins ) or lower ( femoral vein ) catheterization sites .  Lower extremity duplex ultrasound examinations  were performed before central venous catheter placement , after removal of the catheter , and 7 days after catheter removal . Ultrasound examinations were reported as positive , nondiagnostic , or negative for deep vein thrombosis . MEASUREMENTS AND MAIN RESULTS Of the 21 patients r and omized to upper access sites , none developed positive or nondiagnostic duplex ultrasound examinations . Six ( 25 % ) of 24 patients r and omized to the femoral access site developed lower extremity deep vein thrombosis ( p = .02 ) . In addition , seven ( 29 % ) patients r and omized to the lower access site sustained non-diagnostic ultrasound examinations . A total of 13 ( 54 % ) of 24 patients from the lower access group developed abnormal ultrasound examinations ( p < .001 ) . Age , duration of catheterization , coagulation profile , deep vein thrombosis prophylaxis , and Acute Physiology and Chronic Health Evaluation II scores were similar between the upper and lower access groups . CONCLUSIONS Based on the data from this study , we concluded that femoral vein catheterization is associated with a 25 % frequency of lower extremity deep vein thrombosis compared with similar patients receiving subclavian or internal jugular vein catheters . The femoral vein remains an important emergency venous access route . Physicians inserting femoral vein catheters should be aware of the risk of lower extremity deep vein thrombosis and should consider performing lower extremity duplex ultrasound examinations on removal of femoral vein catheters 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 of removal for poor flow ( 16 % in both groups ) or infections ( 6 % in both groups ) , and the local nursing were similar in the two groups . The only difference was the side of cannulation : the right side in 58 % of cases in group 1 and 78 % in group 2 . The angiographic study revealed a stenosis of the vein in 42 % of the subclavian group and in 10 % of the internal jugular group : a dramatic difference in favour of the internal jugular route , whose superiority over the subclavian route is asserted in respect of venous access of dialysed patients Objective To compare colonization and catheter-related bloodstream infection ( CR-BSI ) rates among three insertion sites ( subclavian , internal jugular , femoral ) used for central venous catheter ( CVC ) placement . Design Twenty-four-month prospect i ve study , with relative effects analyzed by Cox proportional hazards regression . Setting Eight-bed intensive care unit . Patients Four hundred and ten critically ill patients requiring CVC placement . Measurements and results All short-term multi-lumen CVCs , including antimicrobial-coated 
    Output:
    
Subclavian and internal jugular CVA routes have similar risks for catheter-related complications in long-term catheterization in cancer patients .
Subclavian CVA is preferable to femoral CVA in short-term catheterization because of lower risks of catheter colonization and thrombotic complications .
In short-term haemodialysis catheterization , femoral and internal jugular CVA routes have similar risks for catheter-related complications except internal jugular CVA routes are associated with higher risks of mechanical complications