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

Abstract

Central venous catheters (CVCs) are frequently used, but the rate of complications is high. This study evaluates the effects of a short training program for CVC insertion in a university-based teaching hospital. A sample of adults with CVCs inserted outside the intensive care unit was selected from two academic years: 2015, year without structured training, and 2016, year with structured training. Clinical and laboratory information, as well as the procedure’s characteristics and complications (mechanical and infectious) were collected. The incidence of complications before and after the training was compared. A total of 1502 punctures were evaluated. Comparing the pre- and post-training period, there was an increase in the choice for jugular veins and the use of ultrasound. A numerical reduction in the rate of complications was identified (RR 0.732; 95% CI 0.48–1.12; P = 0.166). This difference was driven by a statistically significant lower rate of catheter-related infections (RR 0.78; 95% CI 0.64–0.95; P = 0.047). In the multivariate analysis, aspects regarding technique (ultrasound use, multiple punctures) and year of training were associated with outcomes. Structured training reduces the rate of complications related to CVC insertion, especially regarding infections.

Complicações de acessos venosos centrais em um serviço de cirurgia vascular de um hospital de ensino: uma coorte prospectiva

“…Pelo que se tem conhecimento, este é apenas o segundo estudo prospectivo brasileiro a avaliar o desfecho de complicações mecânicas de acessos venosos centrais, sendo o primeiro estudo prospectivo a ser conduzido em um hospital de ensino. Esta coorte apresentou uma incidência de complicações mecânicas de acessos venosos centrais de 16,44% e de falhas de 13,70%, compatíveis com a faixa de frequência encontrada na literatura internacional, que varia de 1,1 a 18% dos procedimentos para as complicações e de 0,4 a 22,3% para as falhas [16][17][18][19][20][21][22][23][24][25][26][27][28][29] .…”

“…Em relação aos estudos nacionais, a incidência de complicações variou de 2,7 a 12% dos procedimentos. Dois dos três estudos foram observacionais e retrospectivos, realizados em hospitais de ensino com 1.502 e 311 cateteres venosos centrais inseridos por médicos-residentes, nos sítios jugular interno e subclávio, e que encontraram, respectivamente, taxas de complicações mecânicas de 2,7% e de 6,5% 18,19 . O terceiro foi um estudo observacional prospectivo, com 421 cateteres de hemodiálise inseridos em sua grande maioria (99%) por angiologistas ou médicos-residentes em Angiologia, com uma incidência de 12% de complicações mecânicas 30 .…”

Needle Insertion Difficulty Algorithm (NIDA): A novel pilot study to predict Huber needle insertion difficulty in totally implanted devices

“…Routine management of port in cancer patients undergoing chemotherapy, blood draws, or catheter irrigations, allowed to evaluate different SPIA type of subcutaneous port implantation. 10 Data collected included the followed variables, specifically:…”

“…8 In medical oncology department, clinicians manage daily these types of venous devices; sometimes, after several unsuccessful attempts, it's required a vascular access expert/specialist clinician's consulting to complete the procedure. [9][10][11][12] This procedure is further complicated when a cancer patient is hospitalized, for various pathologies, in other departments, where clinicians are less used to introducing the Huber needle into the port.…”

Spontaneous Knot Formation in a Central Venous Catheter

“…Mechanical and thrombotic complications during catheter insertion include hematoma formation, pneumothorax, hemothorax, thrombosis, phlebitis, gas embolism, hemorrhage, and inadvertent arterial puncture [ 12 ]. Complications associated with catheter manipulation tend to be infections, such as sepsis [ 14 ].…”