Central venous catheters in prehospital use

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Intravenous literature: Fyntanidou, B., Fortounis, K., Amaniti, K., Katsanoulas, K., Mouloudi, E., Grosomanidis, V. and Boutlis, D. (2009) The use of central venous catheters during emergency prehospital care: a 2-year experience. European Journal of Emergency Medicine. 16(4), p.194-8.

Abstract:

OBJECTIVE: Evaluation of the efficacy and safety of central venous catheter (CVC) use during prehospital emergency care.

METHODS: All prehospital patients who underwent CVC positioning by emergency medical services physicians in the greater area of Thessaloniki during a 2-year period were included. A two-lumen indwelling polyurethane 8F catheter was inserted using the Seldinger technique in all cases. Patients’ demographics and underlying diseases, site of access, number of attempts, time spent for catheter placement, and insertion-related complications were recorded.

RESULTS: Four hundred and ninety-seven CVCs were inserted by emergency medical services physicians during the study period in patients with various underlying diseases [cardiac arrest (35.4%), other cardiac emergencies (16.3%), trauma (30.0%), coma (7.7%)]. Subclavian and internal jugular veins were accessed in 55.3 and 44.15% of patients, respectively. The mean number of attempts was 1.3 and the mean time spent for insertion was 2.0+/-0.5 min. Eleven (2.2%) hematomas at the insertion site of minor clinical importance and five (1.0%) uncomplicated arterial punctures were found. All of the 378 patients referred alive for admission in hospitals after prehospital resuscitation had radiological detection of their CVCs. Catheter malposition occurred in 11 (2.9%) cases. Three pneumothoraces were also detected (0.8%), but only one required chest tube placement.

CONCLUSION: Insertion of CVCs during prehospital emergency care is effective in providing intravenous access, thus facilitating the delivery of fluids and medications in unstable patients. It is safe, as associated with a low incidence of complications in experienced hands.


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