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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

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Abstract

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.

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Authors and Affiliations

  1. Clinic for Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany

    Wolfram Schummer, Claudia Schummer & Samir G. Sakka

  2. Clinic for Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Wolfram Schummer

  3. Department of Methodology and Evaluation Research, Friedrich-Schiller University of Jena, Jena, Germany

    Norman Rose

  4. Clinic for Neurology, Freiburg, Germany

    Wolf-Dirk Niesen

  5. Krankenhaus Merheim, Akademisches Lehrkrankenhaus der Universität Köln, Ostmerheimer Straße 200, 51109, Köln, Germany

    Samir G. Sakka

Authors
  1. Wolfram Schummer
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  2. Claudia Schummer
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  3. Norman Rose
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  4. Wolf-Dirk Niesen
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  5. Samir G. Sakka
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Corresponding author

Correspondence to Wolfram Schummer.

Additional information

The study was performed at the Clinic for Neurology, University Hospital Hamburg-Eppendorf, and the Clinic for Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, both Germany

There are no possible conflicts of interest, sources of financial support, corporate involvement, patent holdings, etc. for any of the authors

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Schummer, W., Schummer, C., Rose, N. et al. Mechanical complications and malpositions of central venous cannulations by experienced operators. Intensive Care Med 33, 1055–1059 (2007). https://doi.org/10.1007/s00134-007-0560-z

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  • DOI: https://doi.org/10.1007/s00134-007-0560-z

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