Immediate complications of central venous cannulation in ICU

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Introduction

Catheterization of the central veins is one of the most widespread procedures in any Intensive Care Unit (ICU). Despite the availability of different literature on anatomy, techniques and the introduction of special ultrasound devices, complications are frequent. Complication rates range from 7-20% according to the literature.

Methods

This is a prospective study to assess the complication rate from central venous cannulation in the ICU. A separate registration form for every attempted catheterization was used. Data collected were: patient's demographics, grade of operator, approach used, number of attempts, indication for insertion, use of ultrasound probe, type of catheter and complications.

Results

In the first three months, 82 patients were involved in the study. There were 120 attempted catheterizations and 115 lines were inserted (success rate, 95.8%). There were 21 complications (complication rate, 17.5%). They were intra-arterial insertion/puncture 9 (7.5%), perivascular insertion 3 (2.5%), pneumothorax 1 (0.83%), bleeding requiring blood transfusion 1 (0.83%), arrhythmias requiring intervention 1 (0.83%), surgical emphysema 1 (0.83%), unsuccessful 5 (4.16%).

Conclusion

The complication rate of central venous catheterization remains high even in experienced hands. Fatal or serious complications are rare. The use of the ultrasound probe may decrease the complication rate even if used for checking the anatomy only. Intra-arterial puncture/insertion, considered by many as a relatively innocent complication, can lead to unnecessary morbidity and even fatal complications, especially in the ITU population with abnormal clotting. Formal teaching should be provided for all new staff in training starting their appointments on the Intensive Care Units.