Percutaneous subclavian vein catheterization. Too much of a good thing?

Abstract

Eighty-one percutaneous subclavian vein catheterizations ( PSVCs ) were randomly selected for retrospective audits. Physicians with varied levels of experience were performing PSVCs in many patient care areas. The incidence of pneumothorax was 12.4%. After impersonal contacts by the audit committee failed to reduce that rate, a concurrent audit process with direct physician contact was initiated. This reduced the complication rate significantly. Because earlier published reports had associated PSVCs with low complication rates, operator caution may have given way to overzealous use by undertrained physicians. Direct physician involvement in quality-assurance programs can enhance patient care.

Adverse events in health care: Setting priorities based on economic evaluation

“…Iatrogenic pneumothorax costs in the order of $4.5 million each year. Rates have been shown to range from as many as one pneumothorax for every three or four central lines placed by inexperienced personnel, 23 to as low as one in a thousand by experts 24 . It is clear that there may be room for improvement in routine clinical practice in Australia.…”

Complications Related to Subclavian Catheters for Hemodialysis

“…Operator inexperience was considered to be the major factor that led to these traumatic complications. Indeed, pneumothorax was reported at a rate of 12.4% in a large teaching hospital where percutaneous subclavian vein catheterizations were performed by a large number of physicians from many different specialities [16].…”

Santral Venöz Kateter (SVK) Malpozisyonlarında Kolay ve Hızlı Tanı: Posterior– Anterior(PA) Akciğer Grafisi: 3 Olgu Sunumu

“…Yapılan bir çalışmada, kateter malpozisyonu olan hastaların akciğer grafilerinde bunu saptama oranının %29-33 arasında olduğu bildirilmektedir (15). Malpozisyonların önlenmesine yönelik özel-likle son yıllarda ultrasonografi (US) eşliğinde kateter yerleştirilmesi güncelliğini korumaktadır.…”