A Contemporary Assessment of Mechanical Complication Rates and Trainee Perceptions of Central Venous Catheter Insertion
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/m2 vs 31.5 kg/m2, 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. Journal of Hospital Medicine 2017;12:646-651. © 2017 Society of Hospital Medicine