Limited data exist regarding rates of mechanical complications associated with placement of non-tunneled acute central venous catheters (CVC) at a training institution. Additionally, trainee perceptions and experiences managing CVC complications are unknown. Our objective is to evaluate modern day CVC mechanical complication rate and associated risk factors. A secondary goal is to explore trainee perspectives surrounding CVC experience, procedural supervision, and perceptions regarding unsuccessful CVC placement.
Between June 1, 2014 to May 1, 2015, we performed a single-center, retrospective study of CVC insertion at an academic tertiary care center. Electronic health records of CVC placement were reviewed to evaluate complications. In addition, an electronic survey was distributed to internal medicine residents. Descriptive statistics were used; t-tests and chi-square tests were used to compare continuous and categorical variables, respectively.
Of seven-hundred thirty reviewed records, 14 serious mechanical complications due to pneumothorax (n=5), bleeding (n=3), vascular injury (n=3) stroke (n=1), and death (n=2) occurred. Factors associated with complications included: subclavian location (21.4% vs 7.5%, p=0.001), number of attempts (2.2 vs 1.5 attempts, p=0.02), unsuccessful line placement (21.4% vs 3.9%, p=0.001), attending presence during procedure (61.5% vs 34.2%, p=0.04), low BMI (25.7kg/m2 vs 31.0kg/m2, p=0.001), anticoagulation (28.6% vs 20.3%, p=0.048), and ventilator use (71.4% vs 62.2%, p=0.001). Of 166 residents, 103 replied to the CVC survey (response rate=62%). Survey data suggested deficiencies in managing unsuccessful CVC procedures; specifically, only 38% (N=30/80) of residents wrote a note routinely after failed CVC attempt, and 35% (N=21/60) ordered a chest x-ray after a failed attempt.
Serious mechanical complications associated with CVC placement occur in 1.9% of cases. Compared to historical data pattern of adverse events, fewer pneumothoraces and more bleeding complications occurred in our study. Some notable risk factors for complications include attending supervision and unsuccessful CVC placement. Attending supervision may be a risk factor due to attending presence for higher risk patients or heightened anxiety of supervised trainees. Unsuccessful CVC attempts are an important risk factor for complications; our study reveals that trainees appear to have substantial knowledge deficiencies regarding management of unsuccessful CVC attempts. Education regarding post-procedural management of unsuccessful CVC placement appears necessary.
To cite this abstract:Heidemann, LA; Chopra, V; Sagana, R; Heung, M . A CONTEMPORARY ASSESSMENT OF MECHANICAL COMPLICATION RATES AND TRAINEE PERCEPTIONS OF CENTRAL VENOUS CATHETER INSERTION. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 24. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/a-contemporary-assessment-of-mechanical-complication-rates-and-trainee-perceptions-of-central-venous-catheter-insertion/. Accessed July 15, 2019.