Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study

Abstract

Background Central venous catheters are essential for management of hospitalized patients, but their insertion is subject to complications that can make them unusable and/or cause patient morbidity. There are few data on the incidence of these complications and the variables associated with these outcomes in Brazil. Objectives To determine the incidence of mechanical complications and failures of short stay central venous catheters fitted by the vascular surgery service at a teaching hospital and identify variables associated with their occurrence. Methods This was a prospective cohort of 73 attempts to fit patients with a central venous catheter performed by the vascular surgery service at a teaching hospital from July to October of 2022. Results Mechanical complications occurred in 12 cannulation attempts (16.44%) and there were 10 failures (13.70%). The factors associated with mechanical complications were less experienced operators (p < 0.001), less specialized operators (p = 0.014), a failed attempt prior to requesting help from the vascular surgery service (p = 0.008), and presence of at least two criteria for difficulty (p = 0.007). Conclusions The local incidence of mechanical complications and central venous cannulation failures was similar to rates described in the international literature, but higher than rates in other Brazilian studies. The results suggest that the degree of experience of the person fitting the catheter, history of a failed prior attempt, and presence of at least two criteria for difficulty identified before the procedure were associated with worse outcomes.

Teaching Medical Procedural Skills for Performance

“…Failure to perform peripheral intravenous cannulation on the first attempt is reported in 40% of cases [ 9 ]. In central venous access procedures, mechanical complications are estimated in 5 to 19% of cannulation attempts with arterial puncture occurring in 4.2% to 9.3% of cases [ 10 ]. Additionally, guidewire retention is increasing, with operator error by trainee doctors responsible for 88% of the cases [ 11 ].…”