Complications of central venous catheter insertion in a teaching hospital

Abstract

Introduction: Central venous catheters are fundamental to daily clinical practice. This procedure is mainly performed by residents, often without supervision or structured training. Objective: To describe the characteristics of central venous catheterization and the complication rate related to it. Method: Retrospective cohort study. Adult patients undergoing central venous catheter insertion out of the intensive care unit (ICU) of a teaching hospital were selected from March 2014 to February 2015. Data were collected from medical charts using an electronic form. Clinical and laboratory characteristics from patients, procedure characteristics, and mechanical and infectious complications rates were assessed. Patients with and without complications were compared. Results: Three hundred and eleven (311) central venous catheterizations were evaluated. The main reasons to perform the procedure were lack of peripheral access, chemotherapy and sepsis. There were 20 mechanical complications (6% of procedures). Arterial puncture was the most common. Procedures performed in the second semester were associated with lower risk of complications (odds ratio 0.35 [95CI 0.12-0.98; p=0.037]). Thirty-five (35) catheter-related infection cases (11.1%) were reported. They were related to younger patients and procedures performed by residents with more than one year of training. Procedures performed after the first trimester had a lower chance of infection. Conclusion: These results show that the rate of mechanical complications of central venous puncture in our hospital is similar to the literature, but more attention should be given to infection prevention measures.

Efficacy and safety of ultrasound-guided cannulation via the right brachiocephalic vein in adult patients

“…They are primarily used when there is no peripheral access, to administer medications requiring large vessels, to provide parenteral nutrition, and to provide access for hemodialysis. [1–3] CVC placement is a challenging and high-risk procedure in patients, even for experienced practitioners. To date, ultrasound (US) is the method of choice for locating vessels and guiding venous punctures in adult and pediatric patients because it increases the odds of success while reducing the number of surgical attempts as well as the associated complications.…”

Reducing central vein catheterization complications with a focused educational program: a retrospective cohort study

“…The use of the subclavian vein is more related to pneumothorax and less related to infections, and the internal jugular vein and femoral vein are more related to arterial perforation 3 , 5 . A previous evaluation at our hospital showed that mechanical complications occurred in 6.5% of procedures and infection complications occurred in 11.1% of procedures 6 .…”

“…These analyses were conducted using SPSS 20.0 software (SPSS, Chicago, IL). Considering that in the previous study, the rate of complications of CVC insertion in the same hospital was 6% 6 , a sample size of 749 procedures was estimated for each year to identify an absolute 3% reduction in the risk of complications related to CVCs.…”

O papel da ecografia vascular no manejo das complicações associadas ao acesso venoso central para hemodiálise em pacientes oncológicos: relato de dois casos e revisão da literatura

“…Central venous catheter (CVC) placement for hemodialysis is a common procedure at large centers, although the health professionals available have not always been properly trained to conduct it. 1 Complications that have been documented include inadvertent arterial puncture with a small needle (5%), passage of the cannula through the artery (0.1 to 0.8%) and consequent hemothorax, hematoma with obstruction of airways, pseudoaneurysm, arteriovenous fistula, and encephalic vascular accident. 2 These devices are associated with around 65% of cases of deep venous thrombosis of the upper limbs, 3 and the incidence of infection is around 1.1-7.5 per 1,000 catheters inserted in cancer patients.…”