scholarly journals Mechanical complications of central venous catheterisation in trauma patients

2017 ◽  
Vol 99 (5) ◽  
pp. 390-393 ◽  
Author(s):  
J Odendaal ◽  
VY Kong ◽  
B Sartorius ◽  
TY Liu ◽  
YY Liu ◽  
...  
Keyword(s):  
Complication Rate ◽  
Guide Wire ◽  
Junior Doctors ◽  
Trauma Patients ◽  
Mechanical Complication ◽  
Central Venous ◽  
Central Venous Catheterisation ◽  
Mechanical Complications ◽  
Trauma Service ◽  
Catheter Dislodgement

INTRODUCTIONCentral venous catheterisation (CVC) is a commonly performed procedure in a wide variety of hospital settings and is associated with appreciable morbidity. There is a paucity of literature focusing on mechanical complications specifically in the trauma setting. The aim of our study was to determine the spectrum of mechanical complications in a high-volume trauma centre in a developing world setting where ultrasound guidance was not available.METHODSA retrospective study was performed analysing data from a four-year period at the Pietermaritzburg Metropolitan Trauma Service in South Africa.RESULTSA total of 178 mechanical complications (18%) occurred in 1,015 patients undergoing CVC: 117 pneumothoraces, 25 malpositions, 18 catheter dislodgements, 14 arterial cannulations, one air embolism, one chylothorax, one pleural cannulation and one retained guide-wire. The internal jugular vein (IJV) approach was associated with a higher overall complication rate than the subclavian vein (SCV) approach (24% vs. 13%, p<0.001). Pneumothorax (73% vs. 57%, p<0.001) and arterial cannulation (15% vs. 0%, p<0.001) were more common with the IJV. Catheter dislodgement (21% vs. 0%, p<0.001) was more common with the SCV. Junior doctors performed 66% of the CVCs and this was associated with a significantly higher complication rate (20% vs. 12%, p<0.001).CONCLUSIONSCVC carries appreciable morbidity, with pneumothorax being the most frequent mechanical complication. The SCV was the most commonly used approach at our institution. The majority of CVCs were performed by junior doctors and this was associated with a considerable complication rate.

Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

2018 ◽  
Vol 35 (9) ◽  
pp. 869-874 ◽  
Author(s):  
Jacob Bell ◽  
Munish Goyal ◽  
Sallie Long ◽  
Anagha Kumar ◽  
Joseph Friedrich ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Complication Rate ◽  
Venous Catheter ◽  
Complication Rates ◽  
Central Venous ◽  
Site Specific ◽  
Mechanical Complications ◽  
Significant Difference ◽  
Insertion Techniques ◽  
Delayed Complications

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. Results: In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. Conclusions: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

Mechanical complications of central venous catheters in children: A cohort study

2021 ◽  
pp. 1-7
Author(s):  
Kieran J. Moore ◽  
David Greencorn ◽  
Nadine Smith ◽  
Joanne M. Langley ◽  
Ketan Kulkarni
Keyword(s):  
Superior Vena ◽  
Tertiary Care ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Mechanical Complication ◽  
Complication Rates ◽  
Care Hospital ◽  
Central Venous ◽  
True Incidence ◽  
Mechanical Complications

Abstract Background: Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear. Setting and methods: Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described. Results: In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications. Conclusions: Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.

Ten Years of Mechanical Complications of Central Venous Catheterization in Trauma Patients

2012 ◽  
Vol 78 (5) ◽  
pp. 545-549 ◽  
Author(s):  
Crystal Ives ◽  
Donald Moe ◽  
Kenji Inaba ◽  
Bernardino Castelo Branco ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Injury Severity ◽  
Central Venous Catheterization ◽  
Unit Length ◽  
P Value ◽  
Trauma Patients ◽  
Central Venous ◽  
Mechanical Complications ◽  
Venous Catheterization

The study purpose was to determine the incidence of mechanical complications (MC) associated with central venous catheterization (CVC) and to evaluate their impact on outcomes. This was a retrospective review of trauma morbidity and mortality records at a Level I trauma center (1999 to 2009). Demographics and outcomes were extracted for all trauma patients with CVC. Patients developing MC were compared with those who did not. Four thousand eight hundred eighteen lines were placed in 2935 patients. Of these, 1.5 per cent (n = 73) had MC. A total of 64.4 per cent (n = 47) were pneumothoraces followed by arterial cannulation at 8.2 per cent (n = 6) and thrombosis at 6.8 per cent (n = 5). The rate of MC by access site was: subclavian 1.8 per cent (n = 52), internal jugular 1.2 per cent (n = 10), and femoral 0.3 per cent (n = 3) (P value for trend = 0.001). Change in management was required in 31.5 per cent (n = 23). Number of lines ( P < 0.001), Injury Severity Score ( P < 0.001), body mass index less than 20 kg/m2 ( P = 0.036), and chest Abbreviated Injury Score greater than3 ( P = 0.034) were significant predictors of MC. Patients with MC had a longer intensive care unit length of stay (18.8 ± 25.7 vs 11.4 ± 13.3; adjusted odds ratio, 5.75; 95% confidence interval, 2.24–9.25; P = 0.001). Incidence of MC was 1.5 per cent. Complications were clinically significant in 31.5 per cent and resulted in longer intensive care unit stays.

scholarly journals Research protocol for mechanical complications after central venous catheterisation: a prospective controlled multicentre observational study to determine incidence and risk factors of mechanical complications within 24 hours after cannulation

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029301
Author(s):  
Maria Adrian ◽  
Ola Borgquist ◽  
Peter Bentzer ◽  
Jonas Åkeson ◽  
Martin Spångfors ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Observational Study ◽  
Real Time ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Central Venous Catheterisation ◽  
Mechanical Complications

IntroductionCentral venous catheterisation is a common procedure in intensive care therapy and the use of central venous catheters is essential for treatment of many medical disorders. Although rare, central venous catheterisation is associated with mechanical complications that can be life-threatening if untreated. Real-time ultrasound guidance reduces the incidence of mechanical complications when compared with the anatomic landmark method. The purpose of this study is to determine the incidence of and potential risk factors associated with early mechanical complications of central venous catheterisation in an era where real-time ultrasound guidance has become clinical practice.Methods and analysisThis is a prospective, controlled, multicentre, observational study. All participating hospitals follow the same clinical guidelines for central venous catheterisation. Each central venous catheter insertion will be recorded in the common electronic chart system according to a recently revised template. An automated script-based search will identify all recorded central venous catheter insertion templates during the study period and relevant variables will be extracted. Outcome measures and independent variables are pre-defined in this study protocol. Multivariable and univariable logistic regression analysis will be used to determine associations and risk factors of mechanical complications.Ethics and disseminationThe Regional Ethical Review Board in Lund, Sweden has approved this study. The results will be submitted for publication in peer-reviewed medical journals and presented at national and international scientific meetings.Trial registration numberNCT03782324.

scholarly journals Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

2019 ◽  
Vol 29 (4) ◽  
pp. 904-913 ◽  
Author(s):  
Amer Sebaaly ◽  
Martin Gehrchen ◽  
Clément Silvestre ◽  
Khalil Kharrat ◽  
Tanvir Johanning Bari ◽  
...  
Keyword(s):  
Complication Rate ◽  
Adult Spinal Deformity ◽  
Spine Deformity ◽  
Mechanical Complication ◽  
Level Of Evidence ◽  
Multicentric Study ◽  
Mechanical Complications ◽  
Roussouly Classification ◽  
Normal Shape

Abstract Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5–4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

scholarly journals 10 Mechanical Complications Associated with Central Venous Catheters at a Canadian Tertiary Care Centre

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e4-e4
Author(s):  
Kieran Moore ◽  
Ketan Kulkarni ◽  
David Greencorn ◽  
Stefan Kuhle ◽  
Joanne Langley
Keyword(s):  
Tertiary Care ◽  
Central Venous Catheters ◽  
Mechanical Complication ◽  
Complication Rates ◽  
Central Venous ◽  
Term Care ◽  
Indwelling Catheters ◽  
Health Care Center ◽  
Mechanical Complications ◽  
Paediatric Patients

Abstract Background The administration of life-saving treatment through central venous catheters (CVC) has significantly improved the quality of life and outcomes for patients, especially for those requiring long-term care. While CVC-associated bacteremia is a standard patient outcome measure, little is known about the incidence of mechanical complications in children. Although common, large data on mechanical complications are scarce and generally limited to specific paediatric populations from modest single center series. Objectives To determine the incidence of mechanical complications among paediatric patients with CVCs. Design/Methods In this retrospective study we analyzed data from all paediatric patients (0-19 years) who required a CVC between 2001 and 2016 at our health care center, which services patients from regional hospitals in a shared care model. Details on CVC insertions and daily records of catheter function while in hospital have been collected prospectively and stored in a dedicated database. Patient demographics, catheter characteristics, and complications were abstracted from the database. Complications were defined through clinician documentation of CVC mechanical failures such as disconnect, leakage, fracture, and blockage. Complication rates were expressed per 1,000 line days. Results A total of 8,747 CVCs were placed in 5,743 patients during the study period for a total of 780,448 line days. Neonatal patients required the most CVC insertions and made up 41% of the cohort studied. Total mechanical complication rates were the highest over the 15-year period in 2001 (12 per 1,000 line days) and lowest in 2013 (3.8 per 1,000 line days). Peripherally inserted central catheters were used in the majority of patients (56%), while port-a-caths made up the vast majority of line days (78%). Mechanical complications occurred more frequently in non-tunneled catheters and were least likely to occur in port-a-caths (43 and 3.1 per 1,000 line days, respectively). Tunneled catheters failed mechanically at a rate of 8.0 per 1,000 line days and the peripherally inserted central catheter complication rate was 17 per 1,000 line days. Conclusion We provide a novel description of the incidence of mechanical complications in the setting of commonly used CVCs in a large paediatric cohort. Our findings help convey the true frequency of mechanical failures and create a benchmark for mechanical CVC complications in children. Recognizing the mechanical limitations of indwelling catheters will assist clinicians in optimizing catheter choice. Future study is planned to identify risk factors associated with CVC complications.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

scholarly journals Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

2020 ◽  
pp. 112972982094406
Author(s):  
Lucio Brugioni ◽  
Elisabetta Bertellini ◽  
Mirco Ravazzini ◽  
Marco Barchetti ◽  
Andrea Borsatti ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Guide Wire ◽  
Case Series ◽  
Venous Catheter ◽  
Venous Access ◽  
Late Complications ◽  
Central Catheter ◽  
Central Venous ◽  
Single Lumen ◽  
Thrombotic Complications

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

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