[Central venous catheterization: complications of different placements].
OBJECTIVE
The aim of this prospective multicentric non-randomised trial was to report the complications of the central venous catheter insertion with different techniques and to assess the advantages of the low lateral approach to the internal jugular vein, according to the technique originally described by Jernigan et al, with our own modifications.


METHODS
From January 1993 to August 1997, 2,290 CVC (2,286 by percutaneous puncture and 4 by surgical approach) were placed. The following complications were analysed prospectively: pneumothorax, accidental arterial puncture, more than two punctures of the same vein, necessity to shift to another venous approach, complete failure, malposition of catheter.


RESULTS
The veins the most frequently used were internal jugular vein (48.7%), femoral vein (27%) and subclavian vein (24.2%). Internal jugular vein was punctured especially by low lateral approach (75%) and subclavian vein by infraclavicular approach (92%). With these two placements, the rate of pneumothorax was 0% and 3.1% respectively (p < 0.001), the rate of accidental arterial puncture was 1% and 2.7% respectively (p < 0.03) and the rate of more than two consecutive punctures was 3.1% and 6.3% respectively (p < 0.008).


CONCLUSIONS
On our experience, we advocate the low lateral approach to the internal jugular vein as first choice technique for venipuncture in both adults and children for both short and long-term central venous approach, because it is associated to high rate of outcome and to low rate of complications in comparison with other techniques.
Iovino
F
F
III Divisione di Chirurgia Generale e Oncologica, Seconda Università degli Studi di Napoli, Piazza Miraglia 2, 80122 Napoli, Italie. fr_iovino@hotmail.com
Pittiruti
M
M
Buononato
M
M
Lo Schiavo
F
F
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D002648:Child; D005268:Femoral Vein; D006801:Humans; D007601:Jugular Veins; D018962:Phlebotomy; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013350:Subclavian Vein; D013997:Time Factors