Subclavian central venous catheter complications at insertion

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The aim of the present study was to determine the success of the placement of CVCs without ultrasonographic guidance and the number and type of complications associated with insertion of these” Hernández-Franco and and Martínez-Ordaz (2018).

Abstract:

BACKGROUND: Central Venous Catheters (CVC) are used as a tool in critically ill patients requiring hemodynamic monitoring and vasopressor support, as well as in stable patients requiring parenteral nutrition or chemotherapy. Placement of a CVC subclavian (CVCs) can present severe complications, even fatal. The aim of the present study was to determine the success of the placement of CVCs without ultrasonographic guidance and the number and type of complications associated with insertion of these.

METHODS: In this retrospective cohort study we included all patient who were submitted to CVCs at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI. The variables studied were: medical indication for the placement, insertion site, duration, withdrawal motive and if there were complications type number and management of these.

RESULTS: 283 patients aged 16-95 years were studied. Fifty-five percent of the patients had already had a catheter placed during a previous hospitalization. In 45% of the patients was the first placement, the antecedent of a previous placement did not increase the complications. The indications for the CVCs were: NPT, preoperative use, severe patients, chemotherapy, inability to channel, and plasmapheresis.

CONCLUSIONS: Placement of a subclavian central venous catheter by trained personnel in patients without risk factors and even without ultrasonographic support is safe and effective, with a success rate of close to 100% in placement, severe complications below 2%, and zero mortality. If the attempts are reduced to two punctures the morbidity can be reduced to almost zero.



Reference:

Hernández-Franco, E.H. and Martínez-Ordaz, J.L. (2018) Subclavian central venous catheter, complications at insertion. Revista Médica del Instituto Mexicano del Seguro Social. 55(Suppl 4), p.S336-S342. Article in Spanish.

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