Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients.
OBJECTIVE
To identify the risk factors of failure and immediate complication of subclavian vein catheterization (SVC).


METHODS
Prospective observational study.


METHODS
Surgical critical care unit of a tertiary university hospital.


METHODS
Critically ill patients requiring a first SVC.


METHODS
Subclavian vein catheterization was attempted in 707 patients without histories of surgery or radiotherapy in the subclavian area. Failed catheterizations, arterial punctures, pneumothoraces and misplacements of the catheter tip were recorded. Risk factors of failure and immediate complication were isolated among patients' characteristics, procedure parameters (side and number of venipunctures) and the operator's experience using a univariate +/- multivariate analysis.


RESULTS
Five hundred sixty-two SVCs (79.5%) were achieved without adverse events. Among the remaining 145 catheterizations, 67 (9.5%) failures, 55 (7.8%) arterial punctures, 22 (3.1%) pneumothoraces and 30 (4.2%) misplacements of the catheter tip occurred. More than one venipuncture was the only risk factor of failed catheterization [2 venipunctures, odds ratio =7.4 (2.1-26); >2 venipunctures, odds ratio =49.1 (16.8-144.1)]. More than one venipuncture and age 77 years or more were predictive of the occurrence of immediate complications [2 venipunctures, odds ratio =3.6 (1.8-7.0); >2 venipunctures, odds ratio =14 (7.7-25.3); age >or=77, odds ratio =1.8 (1.0-3.1)]. The operator's training was not predictive of failed catheterization or immediate complication.


CONCLUSIONS
For SVC, more than one venipuncture is predictive of failed catheterization and immediate complication. Age 77 years or more was predictive of immediate complications.
Department of Anesthesiology, Critical Care and of Emergency, University Hospital of Nîmes, 5 rue Hoche, 30 029 Nîmes Cedex 04, France. jean.yves.lefrant@chu-nimes.fr
J-Y
JY
Lefrant
L
L
Muller
J-E
JE
De La Coussaye
M
M
Prudhomme
J
J
Ripart
C
C
Gouzes
P
P
Peray
G
G
Saissi
J-J
JJ
Eledjam
D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012307:Risk Factors; D013350:Subclavian Vein; D017211:Treatment Failure