Mechanical complications of central venous catheter insertions: A retrospective multicenter study of incidence and risks

Björkander, Malin; Bentzer, Peter; Schött, Ulf; Broman, Marcus; Kander, Thomas

doi:10.1111/aas.13214

Cited by 58 publications

(77 citation statements)

References 32 publications

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“…In about half of these cases, the patients suffered permanent injury of varying degree, which is notable both from an individual and socio‐economical perspective. Taking into consideration the expected incidence of CVC‐complications related to insertion and removal, the reported cases during this time period of seven years are very few . We suspect that far from all severe complications are reported to Löf, which makes it difficult to draw any conclusion on the actual occurrence of these conditions in Sweden during the study period.…”

Section: Discussionmentioning

confidence: 95%

“…However, the total number of patients permanently disabled due to avoidable injuries, cannot be ignored, and should spur further work to reduce the incidence. In a recently published retrospective multicentre study from the south of Sweden on 11 000 CVC‐insertions, an incidence of serious mechanical complications of 0.2% was found . These severe complications could be considered as very rare incidents but an extrapolation gives that about 20 serious mechanical CVC‐complications would occur annually in Sweden.…”

Section: Discussionmentioning

confidence: 99%

“…In this document, data from 1996 to 2007 from Löf and The National Board of Health and Welfare (Socialstyrelsen) showed that CVCs were responsible for 1 to 2 deaths, 3 to 4 life‐threating injuries, and 3 to 4 life‐long injuries annually . In a recently published retrospective multicentre study from southern Sweden on 10 949 CVC‐insertions, an incidence of serious mechanical complications of 0.2% was found . If this figure is used for an extrapolation, around 20 severe mechanical CVC complications would occur annually in Sweden.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of central venous access injuries from claims to the Swedish Patient Insurance Company 2009‐2017

Lindgren

Gustafson

Hammarskjöld

2019

Acta Anaesthesiol Scand

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Introduction Insertion and use of central venous access devices (CVADs) can be associated with serious adverse events. The incidence is generally low but considering the vast use of CVADs the consequences can, from a patient safety and health economics perspective, be severe. No exact knowledge exists of number of catheters or complications in Sweden, as there is currently no comprehensive registry. The aim was to analyse injuries reported to the Swedish National Patient Insurance Company (Löf) within 7 days after insertion or removal of a CVAD. Methods A retrospective analysis of all injuries filed in the period 2009‐2017 was performed, evaluating patient data, type of catheter, insertion technique and type of injury. If the injury was deemed avoidable by Löf, degree of disability and mortality was registered. Results A total of 87 claims of injuries were found of which 36 (41%) were assessed as avoidable. The most common injuries were: bleeding (18%), early infection (17%), pneumothorax (17%) and early thrombosis (15%). No patients died of their injuries, but 17 of 36 suffered permanent disability of varying degrees. Ultrasound‐guided insertion was used in 19% of the cases. Conclusion In Sweden, few injuries related to CVAD use are reported to Löf. About 40% of filed claims were categorized as having an avoidable injury and therefore eligible for compensation. About half of the compensated patients suffered a permanent disability. The results indicate underreporting of CVC‐related injuries in Sweden during the studied time‐period.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of central venous access injuries from claims to the Swedish Patient Insurance Company 2009‐2017

Lindgren

Gustafson

Hammarskjöld

2019

Acta Anaesthesiol Scand

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“…Jug-ular, subclavian, and femoral veins are the major insertion sites. The reported incidence of mechanical complications following central venous catheterization is between 1.1% and 17% and depends on its definition [1]. Among the most frequently reported mechanical complications are accidental artery puncture, bleeding, hematoma, pneumothorax or hemothorax.…”

Section: Introductionmentioning

confidence: 99%

“…The risk of accidental CCA puncture may be related to anatomic variations of the IJV, specifically, its shape and relationship to the artery. However, in some retrospective design studies, the incidence of artery puncture was not reported [1]. The traditional anatomical landmark approach is used to find the correct place in which to insert catheters.…”

Section: Introductionmentioning

confidence: 99%

Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study

2019

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Aim: The most common complication following internal jugular vein catheterization is the puncture of the common carotidartery. We aimed to find an optimal head rotation angle for safe vein catheter insertion while minimizing the risk of arterypuncture.Materials and methods: Eighty-two patients admitted to the intensive care unit were included in the prospective study. Ultrasound examination of the neck vessels on the right side was performed in the neutral position and at a head rotation of 15°, 30°, 45° and 60° to the left. Internal jugular vein and common carotid artery puncture angle, overlapping angle of vein by artery and vein safe puncture angle were evaluated.Results: The internal jugular vein puncture angle increased with head rotation from the neutral position to 30° and 45° and was largest at 60° (p<0.001 for all). The overlapping angle increased significantly at 45° and 60° rotation compared with the neutral position (p<0.001 for all). The vein safe puncture angle was highest at 30° and significantly different from the neutral position and 60° (p=0.003 and p=0.013, respectively).Conclusions: When performing right internal jugular vein catheterization without ultrasound guidance by using an out-of-plane technique, the head should be rotated at 30°, because the overlapping angle increases with further head rotation and can increase the risk of artery puncture.

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Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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Isoniazid toxicity from self‐poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence‐based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty‐three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as “Moderately Dialyzable” by hemodialysis for patients with normal kidney function (quality of evidence = C) and “Dialyzable” by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).

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Mechanical complications of central venous catheter insertions: A retrospective multicenter study of incidence and risks

Cited by 58 publications

References 32 publications

Analysis of central venous access injuries from claims to the Swedish Patient Insurance Company 2009‐2017

Analysis of central venous access injuries from claims to the Swedish Patient Insurance Company 2009‐2017

Optimal head rotation angle for safe right internal jugular vein catheterization using out-of-plane approach: an ultrasonography study

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

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