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A Contemporary Assessment of Mechanical Complication Rates and Trainee Perceptions of Central Venous Catheter Insertion
Author(s) -
Heidemann Lauren,
Nathani Niket,
Sagana Rommel,
Chopra Vineet,
Heung Michael
Publication year - 2017
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2784
Subject(s) - medicine , central venous catheter , pneumothorax , mechanical ventilation , complication , retrospective cohort study , emergency department , emergency medicine , intensive care , catheter , surgery , anesthesia , intensive care medicine , nursing
BACKGROUND Limited data exist regarding rates of mechanical complications of ultrasound‐guided, nontunneled central venous catheters (CVC). Similarly, trainee perceptions surrounding CVC complications are largely unknown. OBJECTIVES To evaluate contemporary CVC mechanical complication rates, associated risk factors, and trainee perspectives. DESIGN A single‐center retrospective review of CVC procedures between June 1, 2014, and May 1, 2015. Electronic survey distributed to internal medicine trainees. SETTING Intensive care units and the emergency department at an academic hospital. MEASUREMENTS Electronic health records of patients with CVC procedures were reviewed for complications. Demographic and procedural characteristics were compared for complicated vs uncomplicated procedures. Student t tests and chi‐square tests were used to compare continuous and categorical variables, respectively. RESULTS Of the 730 reviewed records, 14 serious mechanical complications occurred due to pneumothorax (n = 5), bleeding (n = 3), vascular injury (n = 3), stroke (n = 1), and death (n = 2). Risk factors for complicated vs uncomplicated CVC placement included subclavian location (21.4% vs 7.8%, P = 0.001), number of attempts (2.2 vs 1.5, P = 0.02), unsuccessful CVC (21.4% vs. 4.3%, P = 0.001), attending supervision (61.5% vs 34.7%, P = 0.04), low body mass index (mean 25.7 kg/m 2 vs 31.5 kg/m 2 , P = 0.001), anticoagulation (28.6% vs 20.6%, P = 0.048), and ventilation (78.5% vs 66.5%, P = 0.001). Survey data suggested deficiencies in managing unsuccessful CVC procedures; specifically, only 35% (N = 21/60) of trainees regularly perform chest x‐rays after failed CVC attempt. CONCLUSIONS We observed a 1.9% rate of mechanical complications associated with CVC placement. Our study confirms historical data that unsuccessful CVC attempts are an important risk factor for complications. Education regarding unsuccessful CVC placement may improve patient safety.