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Revisiting Complication Rates of Central Venous Catheters From Different Sites in the Ultrasound Era: Should Subclavian Remain on the Throne?
October 2013, Vol 144, No. 4_MeetingAbstracts Critical Care | October 2013
Revisiting Complication Rates of Central Venous Catheters From Different Sites in the Ultrasound Era: Should Subclavian Remain on the Throne? Taro Minami, MD; Mohamed Ramez Mourad, MD; Khalid Alhourani, MD; Eleanor Summerhill, MD Memorial Hospital of Rhode Island / Warren Alpert Medical School of Brown University, Pawtucket, RI Chest. 2013;144(4_MeetingAbstracts):371A. doi:10.1378/chest.1703977
Abstract SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM PURPOSE: The subclavian (SC) insertion site has been recommended over the internal jugular vein (IJ) or femoral vein for central venous catheter (CVC) insertion. This recommendation is based upon studies performed before ultrasound (US) guided CVC placement became prevalent. The purpose of the present study is to revisit both mechanical and infectious complication rates based upon experience with ultrasound guided CVC placement at our institution. METHODS: We conducted a retrospective chart review of all CVC insertions performed over 6 months (January to June 2012) by ICU physicians. Both mechanical and infectious complications were recorded. Mechanical complications were defined as either pneumothorax, hemothorax, arterial cannulation, bleeding or malposition. Infectious complications were defined as documented line infection with the same pathogen obtained from both blood and catheter tip cultures. Two-tailed Fisher's exact test was used for comparisons between the groups. RESULTS: A total of 47 CVCs were placed during the 6-month period. These included 13 SC, 25 IJ and 9 femoral catheters. All IJ CVC insertions were performed under real-time US guidance. No SC CVCs were inserted via US guidance. 5/9 femoral CVCs were inserted with US. There were no pneumothoraces, hemothoraces, or arterial cannulations at any site. Malpositions were noted in 2/13 SC and 3/25 IJ CVCs (0.154 vs. 0.12, p=1.00). Bleeding complications were not documented in IJ or femoral catheters, but there was 1 hemorrhagic complication with a SC CVC (0.00 vs. 0.0769, p=0.342). There were no infectious complications recorded at any site. CONCLUSIONS: In this single institution study, there were no infectious complications of CVC insertion at any of the three sites within a six month period of time. In addition, there were
no mechanical complications of pneumothorax, hemothorax, or arterial cannulation noted. However, there was a non-significant trend toward a higher rate of malposition and bleeding at the SC site compared with the IJ. CLINICAL IMPLICATIONS: The results of this study call into question the previously held notion that the SC CVC site carries the least number of complications. The emergence of ultrasound guidance for line placement may be the key to our findings. As this is a small, single center retrospective study, further studies will be necessary before final recommendations can be made. DISCLOSURE: The following authors have nothing to disclose: Taro Minami, Mohamed Ramez Mourad, Khalid Alhourani, Eleanor Summerhill No Product/Research Disclosure Information
Revisiting Complication Rates of Central Venous Catheters From Different Sites in the Ultrasound Era: Should Subclavian Remain on the Throne? Taro Minami, MD; Mohamed Ramez Mourad, MD; Khalid Alhourani, MD; Eleanor Summerhill, MD Memorial Hospital of Rhode Island / Warren Alpert Medical School of Brown University, Pawtucket, RI Chest. 2013;144(4_MeetingAbstracts):371A. doi:10.1378/chest.1703977
Abstract SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM PURPOSE: The subclavian (SC) insertion site has been recommended over the internal jugular vein (IJ) or femoral vein for central venous catheter (CVC) insertion. This recommendation is based upon studies performed before ultrasound (US) guided CVC placement became prevalent. The purpose of the present study is to revisit both mechanical and infectious complication rates based upon experience with ultrasound guided CVC placement at our institution. METHODS: We conducted a retrospective chart review of all CVC insertions performed over 6 months (January to June 2012) by ICU physicians. Both mechanical and infectious complications were recorded. Mechanical complications were defined as either pneumothorax, hemothorax, arterial cannulation, bleeding or malposition. Infectious complications were defined as documented line infection with the same pathogen obtained from both blood and catheter tip cultures. Two-tailed Fisher's exact test was used for comparisons between the groups. RESULTS: A total of 47 CVCs were placed during the 6-month period. These included 13 SC, 25 IJ and 9 femoral catheters. All IJ CVC insertions were performed under real-time US guidance. No SC CVCs were inserted via US guidance. 5/9 femoral CVCs were inserted with US. There were no pneumothoraces, hemothoraces, or arterial cannulations at any site. Malpositions were noted in 2/13 SC and 3/25 IJ CVCs (0.154 vs. 0.12, p=1.00). Bleeding complications were not documented in IJ or femoral catheters, but there was 1 hemorrhagic complication with a SC CVC (0.00 vs. 0.0769, p=0.342). There were no infectious complications recorded at any site. CONCLUSIONS: In this single institution study, there were no infectious complications of CVC insertion at any of the three sites within a six month period of time. In addition, there were
no mechanical complications of pneumothorax, hemothorax, or arterial cannulation noted. However, there was a non-significant trend toward a higher rate of malposition and bleeding at the SC site compared with the IJ. CLINICAL IMPLICATIONS: The results of this study call into question the previously held notion that the SC CVC site carries the least number of complications. The emergence of ultrasound guidance for line placement may be the key to our findings. As this is a small, single center retrospective study, further studies will be necessary before final recommendations can be made. DISCLOSURE: The following authors have nothing to disclose: Taro Minami, Mohamed Ramez Mourad, Khalid Alhourani, Eleanor Summerhill No Product/Research Disclosure Information