Prevention of complications in permanent central venous catheters.
As more patients are requiring permanent central venous catheters (PCC) for long term venous access, several associated complications have become evident, including: 1, sepsis; 2, thrombophlebitis; 3, insertion complications, such as unsuccessful placement, bleeding and pneumothorax, and 4, PCC transection with tip embolization. At our institution, 162 PCC were placed by way of cutdown or percutaneously. Sepsis occurred in 20 per cent (0.13 septic episodes per 100 catheter days), nearly always involving immunocompromised patients. Twenty-five per cent resolved with use of antibiotics and without removal of PCC. Two patients presented with clinical thrombophlebitis; both were treated with removal of PCC and anticoagulant medication. Failure of insertion was highest with the cephalic cutdown approach, and pneumothorax was highest with the subclavian approach. Transection of PCC is associated with the percutaneous subclavian approach and is heralded by intermittent catheter function and a "pinch-off" sign on roentgenogram. Methods of preventing these complications are emphasized herein.
Takasugi
J K
JK
Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California 90027.
O'Connell
T X
TX
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D006801:Humans; D010353:Patient Education as Topic; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D011182:Postoperative Care; D012189:Retrospective Studies; D013350:Subclavian Vein; D013924:Thrombophlebitis / Q000517:prevention & control*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D004364:Pharmaceutical Preparations