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Letters |

Femoral vs Jugular Venous Catheterization for Short-term Dialysis Access

Saravanan Balamuthusamy, MD; Ivo Lukitch, MD; Eric E. Simon, MD
JAMA. 2008;300(15):1760-1761. doi:10.1001/jama.300.15.1760-c.
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To the Editor: In their randomized trial of femoral vs jugular venous catheterization and nosocomial events in adults requiring acute renal replacement therapy, Dr Parienti and colleagues1 noted thrombotic events in the analyzed groups. It is unclear whether these events were precipitated by the catheters or occurred secondary to the multiple risk factors in the study population.

The authors did not comment on thrombus around the catheter insertion site. Femoral catheters are associated with thrombotic events,2 but the occurrence of significant pulmonary embolism secondary to thrombus around the dialysis catheter remains unclear. In addition, it is not known whether there is a greater risk for pulmonary embolism with thrombus around the catheter site if it is located in the femoral vein or the internal jugular vein. There are no definite guidelines for removal of dialysis catheters if a thrombus is identified around the catheter insertion site, and the risks for fatal and nonfatal pulmonary embolism in these patients remain uncertain.

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October 15, 2008
Lewis Eisen, MD
JAMA. 2008;300(15):1760-1761. doi:10.1001/jama.300.15.1761-a.
October 15, 2008
Jean-Jacques Parienti, MD, DTM&H
JAMA. 2008;300(15):1760-1761. doi:10.1001/jama.300.15.1761-b.
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