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Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients.
- Source :
-
Intensive Care Medicine . Jun2007, Vol. 33 Issue 6, p1055-1059. 5p. 1 Diagram, 1 Chart, 1 Graph. - Publication Year :
- 2007
-
Abstract
- <bold>Objective: </bold>Incidence of primary mechanical complications and malpositions associated with landmark-guided central venous access procedures (CVAP) performed by experienced operators.<bold>Design: </bold>Prospective 5-year observational study on two intensive care units.<bold>Intervention: </bold>Only CVAPs using Seldinger technique were evaluated. Age, gender, puncture site, number of cannulation attempts, and complications within 24 hours and malpositions were recorded.<bold>Patients: </bold>782 CVAPs in females aged 9-92 yrs and 1012 CVAPs in males aged 6-89 yrs.<bold>Results: </bold>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.<bold>Conclusions: </bold>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]
Details
- Language :
- English
- ISSN :
- 03424642
- Volume :
- 33
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Intensive Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 25200905
- Full Text :
- https://doi.org/10.1007/s00134-007-0560-z