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Objective: Incidence of primary mechanical complications and malpositions associated with landmark-guided central venous access procedures (CVAP) performed by experienced operators.Design: Prospective 5-year observational study on two intensive care units.Intervention: Only CVAPs using Seldinger technique were evaluated. Age, gender, puncture site, number of cannulation attempts, and complications within 24 hours and malpositions were recorded.Patients: 782 CVAPs in females aged 9-92 yrs and 1012 CVAPs in males aged 6-89 yrs.Results: We analyzed 1794 (1017 right- and 777 left-sided CVAP), of which 87.7% were accomplished without adverse events. More than one cannulation attempt was a risk factor for failed catheterization, other mechanical complications but not for malposition. Complications/malpositions were encountered in 220 CVAPs.In 51 CVAPs (2.8%) the cannulation failed at the attempted site, here 18 CVAPs were accompanied by further complications (35.3%). Otherwise, the rate for mechanical complications was low (3.3%). The most common mechanical complications (n = 127) were arterial punctures (n = 52; 2.9%), including four arterial cannulations (0.2%), and pneumothorax (n = 9; 0.6%). There was significant risk for arterial puncture with the internal jugular vein approach in comparison to the innominate vein (p = 0.004), but not to the subclavian vein (p = 0.065). Male patients had a lower risk for failure (2.1%) than females (3.8%, p = 0.028). One-hundred-twenty-one central venous catheters were malpositioned (6.7%) of which 35 were related to the left internal jugular vein.Conclusions: Even experienced operators cause a considerable number of early mechanical complications and malpositions. After two unsuccessful cannulation attempts failure and associated complications are very likely. [ABSTRACT FROM AUTHOR]

Objective: A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance.Design: A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position.Setting: We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital.Patients and Participants: The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out.Measurements and Results: The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%.Conclusions: This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated correct insertion depth for central venous catheters (CVC). Topics explored include the need to consider the body weight of the patient prior to CVC insertion, the use of electrocardiogram (ECG), transesophageal echocardiogram (TEE), and chest X-ray (CXR) results in determining CVC insertion depth and positioning, and the need for healthcare practitioners to acknowledge risks associated with malpositioning of CVC.