Placement and maintenance of central venous catheters – risks, complications, benefits

C. Zdrehuş, G. Gavrea, C.N. Casian, I. Acalovschi
Catedra A.T.I., Universitatea de Medicină şi Farmacie „Iuliu Haţieganu” Cluj-Napoca

Abstract

The risks and complications of central venous catheters was evaluated in 56 patients (28 males and 28 females) submitted for catheterization of internal jugular vein and subclavian vein. For internal jugular vein catheterization the middle approach was used in 45 patients, the posterior approach in 4 patients, and the anterior approach in 2 patients. For subclavian vein catheterization the subclavicular site of puncture was preferred in all 5 patients.
We found a direct relationship between the professional level of expertise and incidence of complications on insertion. Consultants and specialists in anaesthesia and intensive care performed 24 catheterizations. A number of 22 (91.66%) of these had no complications on insertion. Registrars I and II performed 15 central venous catheterizations, only one (6.66%) of which was uneventful. Registrars III performed 8 catheterizations, 3 (37.5%) of which were without complications and registrars IV and V performed 9 catheterizations, 6 (66.66%) of which had no complications on insertion. Mean time of maintenance in place of the catheters was 7.44±4.07 days. Catheter infection was documented in 8 (16.2%) cases out of 49, for which we performed microbiological tests. Catheter thrombosis occurred in 6.97% of patients, and the correct position of the catheter tip was found on chest X-Ray examination in 94.11% of patients. Accidental puncture of carotid artery occurred in 8.93% of patients and 3 (5.88%) patients developed unilateral haemothorax.
Individual clinical factors must dictate the choice of access point and site of the catheter. The risks of central venous catheterization can be reduced only by clinicians who have detailed knowledge of the complications of catheterization and also improved skills and techniques. Above all, this procedure requires meticulous attention to detail.

Key words: central venous catheterization, level of expertise, complications, risks

Plasarea şi menţinerea cateterelor venos centrale – riscuri, complicaţii, beneficii

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.1, 20-23