Complications of central venous catheters and their prevention
- Michael P Young, MD
Michael P Young, MD
- Professor of Medicine
- Wake Forest University
Insertion of a central venous catheter (CVC) in a human was first reported by Werner Forssman, a surgical intern, who described canalizing his own right atrium via the cephalic vein in 1929. A technique that facilitates catheter placement into lumens and body cavities was subsequently introduced by Sven-Ivar Seldinger in 1953 . Insertion of a CVC using the Seldinger technique has revolutionized medicine by allowing the central venous system to be accessed safely and easily .
CVCs are now common among critically ill patients. In the United States, over 15 million catheter days/year are recorded in the intensive care unit alone . Multi-lumen CVCs have become ubiquitous in the intensive care unit (ICU). New catheter designs, standardization of insertion techniques and subsequent central line management have reduced complication rates.
Mechanical complications associated with CVC placement and removal, and strategies to these prevent complications, are discussed here. The placement of central venous catheters and infectious and thrombotic complications are discussed separately. (See "Overview of central venous access", section on 'Indications' and "Diagnosis of intravascular catheter-related infections" and "Catheter-related upper extremity venous thrombosis" and "Epidemiology, pathogenesis, and microbiology of intravascular catheter infections".)
Numerous complications are associated with central venous catheter (CVC) placement. The most common are listed in the table (table 1).
Published rates of cannulation success and complications vary according to the anatomic site and operator experience. As an example, one review described an overall complication rate of 15 percent , while an observational cohort study of 385 consecutive CVC attempts over a six month period found that mechanical complications occurred in 33 percent of attempts . Complications included failure to place the catheter (22 percent), arterial puncture (5 percent), catheter malposition (4 percent), pneumothorax (1 percent), subcutaneous hematoma (1 percent), hemothorax (less than 1 percent), and asystolic cardiac arrest (less than 1 percent).
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- Catheter-related infection
- Catheter-induced thrombosis
- Vascular injury
- Pulmonary complications
- Venous air embolism
- PREVENTING COMPLICATIONS
- Mechanical problems
- - Appropriate operator experience
- - Limiting attempts
- - Ultrasound guidance
- - Confirm catheter positioning
- - Preventing air embolism
- SUMMARY AND RECOMMENDATIONS