Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study

Adrian, Maria; Borgquist, Ola; Kröger, Tina; Linné, Erik; Bentzer, Peter; Spångfors, Martin; Åkeson, Jonas; Holmström, Anders; Linnér, Rikard; Kander, Thomas

doi:10.1016/j.bja.2022.08.036

Cited by 24 publications

(32 citation statements)

References 32 publications

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“…4,24,32,33 Several studies, both landmark and real-time ultrasoundguided insertions, have reported a higher number of cannulation attempts to be an important risk factor for mechanical complications in general. 5,11,14,25,34,35 In agreement with that, an increasing number of skin punctures was associated with major tip misplacement in the present study. One explanation for this association may be that insertion problems due to patient factors such thrombosis or anatomical variations may lead to more puncture attempts and more tip misplacements.…”

Section: Discussionsupporting

confidence: 92%

“…This exploratory study is a sub‐study of the CVC‐MECH trial 14 which was approved by the Swedish Ethical Review Authority (Dnr 2018/295). As the study did not include any interventions the Authority waived the requirement for informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…All data were prospectively collected as described in detail in the Methods section of the main study. 14 The follow-up time was 24 h after the insertion. In reasonable time after documentation of the CVC insertion, a careful review of the patients' medical records including all relevant CVC insertion information and radiologic evaluations of chest radiographies, was performed by dedicated collaborators (researchers, research nurses or medical secretaries), thereby enabling operators to correct inadequate or missing information.…”

Section: Data Collectionmentioning

confidence: 99%

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Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations

Ängeby,

Adrian,

Bozovic

et al. 2024

Acta Anaesthesiol Scand

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BackgroundThere is a paucity of data on the incidence of central venous catheter tip misplacements after the implementation of ultrasound guidance during insertion. The aims of the present study were to determine the incidence of tip misplacements and to identify independent variables associated with tip misplacement.MethodsAll jugular and subclavian central venous catheter insertions in patients ≥16 years with a post‐procedural chest radiography at four hospitals were included. Each case was reviewed for relevant catheter data and radiologic evaluations of chest radiographies. Tip misplacements were classified as ‘any tip misplacement’, ‘minor tip misplacement’ or ‘major tip misplacement’. Multivariable logistic regression analyses were used to investigate associations between predefined independent variables and tip misplacements.ResultsA total of 8556 central venous catheter insertions in 5587 patients were included. Real‐time ultrasound guidance was used in 91% of all insertions. Any tip misplacement occurred (95% confidence interval) in 3.7 (3.3–4.1)% of the catheterisations, and 2.1 (1.8–2.4)% were classified as major tip misplacements. The multivariable logistic regression analyses showed that female patient gender, subclavian vein insertions, number of skin punctures and limited operator experience were associated with a higher risk of major tip misplacement, whereas increasing age and height were associated with a lower risk.ConclusionsIn this large prospective multicentre cohort study, performed in the ultrasound‐guided era, we demonstrated the incidence of tip misplacements to be 3.7 (3.3–4.1)%. Right internal jugular vein catheterisation had the lowest incidence of both minor and major tip misplacement.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

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Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations

Ängeby,

Adrian,

Bozovic

et al. 2024

Acta Anaesthesiol Scand

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“…For many critically ill patients, the insertion of central venous catheters (CVCs) is necessary to provide routine clinical care. Yet CVC placement comes with appreciable risk: complications such as inadvertent arterial puncture, pneumothorax, bleeding, and bloodstream infections can occur in up to 5–25% of insertions (1, 2). Because the frequency of these complications varies depending on anatomic location of the CVC (internal jugular vein [IJV], subclavian vein [SCV], and the femoral vein [FV]) (1), clinicians weigh the risk profile of each candidate site and select the one best suited to their patients’ needs.…”

mentioning

confidence: 99%

“…Furthermore, the SCV is accessible when patients are placed in a cervical spine collar or when the head of the bed is occupied for other resuscitative interventions (such as securing the airway). We cannot deny that SCV cannulation, when compared with the IJV or FV cannulation, carries a higher risk of pneumothorax (2). However, the bold clinician who bears this upfront risk is rewarded with a central line that is more comfortable for patients, easy to care for, and associated with reduced rates of thrombosis and catheter-associated bloodstream infections (4).…”

mentioning

confidence: 99%

Ultrasound-Guided Subclavian Central Venous Catheter Insertion: A Slow Return to Former Glory*

Prager

Basmaji

2023

Critical Care Medicine

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For many critically ill patients, the insertion of central venous catheters (CVCs) is necessary to provide routine clinical care. Yet CVC placement comes with appreciable risk: complications such as inadvertent arterial puncture, pneumothorax, bleeding, and bloodstream infections can occur in up to 5-25% of insertions (1, 2). Because the frequency of these complications varies depending on anatomic location of the CVC (internal jugular vein [IJV], subclavian vein [SCV], and the femoral vein [FV]) (1), clinicians weigh the risk profile of each candidate site and select the one best suited to their patients' needs.The SCV was historically a popular choice among acute care physicians for several reasons. Anatomic landmarks that guide SCV cannulation remain prominent regardless of body habitus (3). Furthermore, the SCV is accessible when patients are placed in a cervical spine collar or when the head of the bed is occupied for other resuscitative interventions (such as securing the airway). We cannot deny that SCV cannulation, when compared with the IJV or FV cannulation, carries a higher risk of pneumothorax (2). However, the bold clinician who bears this upfront risk is rewarded with a central line that is more comfortable for patients, easy to care for, and associated with reduced rates of thrombosis and catheter-associated bloodstream infections (4). For these reasons, SCV catheters were granted tenancy in ICUs and emergency rooms.The advent of ultrasound brought about a paradigm shift in CVC insertions. Real-time visualization of the needle as it traverses critical anatomic structures meant fewer complications for critically ill patients with little tolerance for iatrogenic misadventures. For certain anatomical sites such as the IJV and FV, ultrasound guidance streamlined well-established landmark-based insertion techniques. For the SCV, ultrasound guidance was seen as an encumbrance. The clavicle, while a critical landmark for "blind" SCV CVC insertion, obscures the ultrasonographic waves and makes imaging guidance more challenging (5). To visualize the needle, vessel penetration needed to occur at a steeper angle and at a more lateral insertion site near the axillary vein (5). For clinicians, using ultrasound to guide SCV catheterization required an overhaul of previously established practices. In addition, the nuances of image acquisition mandated a higher level of competency and expertise in ultrasound. With ultrasound adoption still in its infancy and operator expertise lacking, the enthusiasm for performing ultrasound-guided SCV catheterization waned.In contrast to SCV CVC insertion, the widespread adoption of ultrasoundguided IJV and FV CVC insertion generated more scientific evidence undergirding its use. Clinical practice guidelines recommended the routine use of ultrasound to guide the insertion of IJV and FV over the SCV (6), further

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The safe implementation of peripherally inserted central catheters by nurse practitioners for patients with gastroenterological diseases in Japan: a single-center retrospective study

Takematsu,

Shibasaki,

Tanaka

et al. 2023

Surg Today

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Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study

Cited by 24 publications

References 32 publications

Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations

Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations

Ultrasound-Guided Subclavian Central Venous Catheter Insertion: A Slow Return to Former Glory*

The safe implementation of peripherally inserted central catheters by nurse practitioners for patients with gastroenterological diseases in Japan: a single-center retrospective study

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