Bibliographic information
GuidelineGuidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: part 2: central venous catheters
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
WHO suggests using the subclavian or jugular veins over the femoral vein for central venous catheter (CVC) insertion in adults, adolescents, children and neonates. (Short- and long-term catheters) (All population)
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- The GDG acknowledged that the risk and benefit of different insertion sites should be considered on an individual basis regarding infectious (that is, CLABSI) and non-infectious complications (in particular, pneumothorax).
- It is important to ensure that clinicians are appropriately trained in CVC insertion to reduce the risk of complications.
- In some emergency situations, the need to prioritize and rapidly establish an IV access may also determine the choice of access site. Insertion into the subclavian site is technically more difficult and requires additional and appropriate training.
- The subclavian site should be avoided in patients currently receiving or likely to require haemodialysis due to the risk of subclavian vein stenosis (201, 202).
- Subclavian vein access carries a risk of pneumothorax, particularly in mechanicallyventilated patients. Additionally, achieving haemostasis can be difficult in individuals with thrombocytopenia or an elevated bleeding risk, further increasing the likelihood of adverse outcomes. Given these concerns, caution should be exercised when considering subclavian access in these scenarios.