Scientific paper
Long-term central venous catheters: size and location do matter

Presented at the 48th Annual Meeting of the Midwest Surgical Association, Ontario, Canada, August 14–17, 2005
https://doi.org/10.1016/j.amjsurg.2005.10.044Get rights and content

Abstract

Background

Right or left side of placement for subclavian vein catheterization for placement of long-term central catheters and size of the catheters has not been analyzed completely.

Methods

The records of 502 consecutive long-term central venous catheters placed in patients while in the operating room over a 1-year period were reviewed and 230 subclavian vein tunneled catheters were analyzed. Technical difficulties in placing the catheters were defined as arterial puncture, guidewire malposition, catheter malposition, need to switch site of access, sheath difficulty, and inability to place the catheter.

Results

Three complications were identified (1%) and technical difficulties occurred in 15% of the patients. More difficulty was associated with the insertion of larger triple-lumen catheters than smaller single-lumen catheters (31% vs. 11%, respectively; P < .009). Right subclavian placement was associated with a 24.4% technical difficulty rate versus a 10.4% technical difficulty rate for left subclavian placement (P < .005).

Conclusions

This study supports placing the smallest catheter necessary via the left subclavian vein.

Section snippets

Methods

A retrospective review over a 1-year time period of all consecutively placed long-term central venous catheters in the operating room was performed. The study sources included dictated surgical notes, operating room records, hospital records, radiology reports, office charts, and quality-assurance conference records. The patient and surgical data were recorded and analyzed (StatGraphics, Herndon, VA). The most common technique of insertion has been described previously by Stellato et al [3].

Results

During a 1-year time period, 502 long-term venous catheters were placed in patients in the operating room. This included 251 externally tunneled centrally inserted venous access devices without a subcutaneous port, 94 with a subcutaneous port, 141 dialysis catheters, and 16 plasmapheresis catheters. To control the inherent differences in placement and indications between these specific catheters, the study was limited to the 230 consecutively placed externally tunneled, silicone rubber, venous

Comments

Many complications can occur with the insertion of long-term central venous access catheters including pneumothorax, hemothorax, subclavian artery puncture, catheter malposition, pericardial tamponade, air embolization, chylothorax, hydrothorax, nerve injury, arrhythmia, and osteomyelitis of the clavicle [4]. The overall major complication rate was 1% in our study, which is consistent with other studies that have shown how safely these catheters can be placed. Many studies report complications

Conclusions

These data indicate that placing large triple-lumen catheters and right subclavian vein punctures were associated with a significantly greater technical difficulties and a greater complication rate. Overall the complication rate was low, showing that the placement of these catheters is safe. Based on these findings we recommend using the smallest catheter possible and to attempt initial placement via the left subclavian vein.

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    Citation Excerpt :

    It was reported that image guidance could decrease the difference of success between experienced and inexperienced operators, and also could be of help to a skillful operator who is otherwise unable to cannulate.7 In the presented series, the technical success of image-guided catheterization was 100% in 1418 patients, as in other radiologic series,1,2,4,5,11–13 whereas technical placement failure occurred in up to 10% of cases in the surgical series.6–8 On the other hand, the difference between the complications of right and left side attempts was not observed in our study.

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