Complications of central venous catheters and their prevention
- Michael P Young, MD
Michael P Young, MD
- Professor of Medicine
- Geisel School of Medicine at Dartmouth
Insertion of a central venous catheter 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 central venous catheter using the Seldinger technique has revolutionized medicine by allowing the central venous system to be accessed safely and easily .
Central venous catheters 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 . Multilumen central venous catheters have become ubiquitous in the intensive care unit. New catheter designs, standardization of insertion techniques, use of ultrasound guidance, and subsequent central line management have reduced complication rates.
Mechanical complications associated with central venous catheter 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 placement. The most common are listed in the table (table 1).
Published rates of cannulation success and complications vary according to the anatomic site, the use of ultrasound guidance, and operator experience. As an example, one review described an overall complication rate of 15 percent , while an observational cohort study of 385 consecutive central venous catheter 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). In the past decade, the mechanical complication rate and failure rate have significantly decreased with the use of ultrasound-guided cannulation, especially for catheter insertion using the internal jugular site. The advantage of using ultrasound guidance is less well established when using the femoral or subclavian vein approach . (See "Principles of ultrasound-guided venous access".)
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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