Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

Bell, Jake; Goyal, Munish; Long, Stacey R.; Kumar, Anagha; Friedrich, Joseph; Garfinkel, Jonathan H.; Chung, Suzi; Fitzgibbons, Shimae

doi:10.1177/0885066618795126

Cited by 29 publications

(23 citation statements)

References 33 publications

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“…Infectious complications are reported to occur in 5% to 26% of patients, mechanical complications in 5% to 19%, and thrombotic complications in 2% to 26% [1], [13]. A recent study by Bell et al showed no statistically significant difference between internal jugular and subclavian vein approach CVC [12]. A study by Herts et al demonstrated a 6% complication rate of using power injection of contrast media through central venous catheters for CT examinations [17], without mention of SVC pericardial communication during the injection.…”

Section: Discussionmentioning

confidence: 98%

“…Mechanical complications of CVC include retained guidewire, arterial injury, and pneumothorax. Duration-associated complications include deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections [9], [10], [11], [12]. Infectious complications are reported to occur in 5% to 26% of patients, mechanical complications in 5% to 19%, and thrombotic complications in 2% to 26% [1], [13].…”

Section: Discussionmentioning

confidence: 99%

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Unusual intravascular complication of right internal jugular vein catheter piercing the SVC into the pericardium: Case report

Bosemani

Sakthivel

2019

Radiology Case Reports

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Iatrogenic superior vena cava pericardial fistula caused by central venous catheterization is rare but can lead to life-threatening condition. Despite the potential risk of pericardial effusion causing pericardial tamponade, a conservative watch and wait management strategy can be safely adopted if such procedural complication is encountered. Herein, we present a case of an incidental finding of a central venous catheter perforating the wall of the superior vena cava into the pericardium, which probably occurred during injection of intravenous contrast agent on computed tomography pulmonary angiogram study.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Unusual intravascular complication of right internal jugular vein catheter piercing the SVC into the pericardium: Case report

Bosemani

Sakthivel

2019

Radiology Case Reports

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“…Recognised complications from central venous line insertion include infection; line related thrombosis; bleeding; pneumothorax; haemothorax; retained guidewires, and; iatrogenic arterial injury [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

Sinha

Saha

Nabil

et al. 2020

Preprint

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Background: Vascular access support teams have been set up to help offload procedural tasks from critical care teams during the coronavirus disease 2019 (COVID-19) global pandemic. However, the impact of VAST on clinical outcomes and on workload has not been shown previously with no reports to date from the UK. Our aim was to evaluate clinical outcomes of a multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Methods: Prospectively collected data on all patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. We report access-related complication until discharge from centre and description of results of online survey.Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line (n=146) was inserted in 96 out of 122 patients (78.7%) and n=18 patients (14.7%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs.Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

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“…Im Vergleich zu anderen Punktionsstellen, wie der V. jugularis interna oder der V. femoralis, verfügt der VSK über eine geringere Thromboseund Infektionsrate [19,20,27]. Auch bei der arteriellen Fehlpunktion ist der VSK überlegen [3,4,19,26]. Dagegen sind der sehr seltene Hämatothorax oder der in 0,1-3,1 % der Fälle vorkommende Pneumothorax häufiger beim VSK zu sehen [3,8,12,18].…”

Section: Hintergrund Und Fragestellungunclassified

“…Auch bei der arteriellen Fehlpunktion ist der VSK überlegen [3,4,19,26]. Dagegen sind der sehr seltene Hämatothorax oder der in 0,1-3,1 % der Fälle vorkommende Pneumothorax häufiger beim VSK zu sehen [3,8,12,18].…”

Section: Hintergrund Und Fragestellungunclassified

Komplikationen und Erfolgsraten des Vena-subclavia-Katheters in Abhängigkeit der Erfahrung

et al. 2020

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Zusammenfassung Hintergrund Die Punktion der V. subclavia gehört zu den Standardprozeduren eines/einer Anästhesisten/Anästhesistin. Gefürchtete Komplikationen dieser Prozedur sind der Pneumothorax und die arterielle Fehlpunktion. Zum Erlernen dieser Prozedur ist von einer gewissen Lernkurve auszugehen. Ziel der Arbeit In dieser Studie soll der Einfluss der Punktionserfahrung auf die Erfolgsquote und mechanische Komplikationen wie Pneumothorax und arterielle Punktion untersucht werden. Dazu sollen 3 Erfahrungsstufen miteinander verglichen werden: unerfahren: 0 bis 20 Punktionen, mäßig erfahren: 21 bis 50 und erfahren: über 50 Punktionen. Material und Methoden Post-hoc-Analyse einer vorab publizierten Nichtunterlegenheitsstudie zur Untersuchung des Einflusses der Beatmung auf die Pneumothoraxrate bei der V.-subclavia-Punktion in Landmarkentechnik. Es wurden 1021 Patienten ausgewertet, die in die vorab publizierte Studie zwischen August 2014 und Oktober 2017 eingeschlossen wurden. Ergebnisse Die Gesamtrate an mechanischen Komplikationen ist in der Gruppe der Unerfahrenen im Vergleich zur Gruppe der Erfahrenen signifikant höher (15 % vs. 8,5 %, p = 0,023). Ebenso ist die Rate an Punktionsversuchen in der Gruppe der Unerfahrenen (0–20) mit 1,85 ± 1,12 signifikant höher als in der Gruppe der Erfahrenen (1,58 ± 0,99, p = 0,004). Im Gegenzug war die Rate einer erfolgreichen Punktion mit 95,1 % in der Gruppe der Erfahrenen signifikant höher als in der Gruppe der Unerfahrenen (89,3 %, p = 0,001). Schlussfolgerung Für eine erfolgreiche Punktion der V. subclavia in Landmarkentechnik ist eine Lernkurve von mindestens 50 Punktionen nötig, um die Komplikationsrate zu senken und die Erfolgsrate zu steigern.

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Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

Abstract: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

Cited by 29 publications

References 33 publications

Unusual intravascular complication of right internal jugular vein catheter piercing the SVC into the pericardium: Case report

Unusual intravascular complication of right internal jugular vein catheter piercing the SVC into the pericardium: Case report

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

Komplikationen und Erfolgsraten des Vena-subclavia-Katheters in Abhängigkeit der Erfahrung

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