Eliminating arterial injury during central venous catheterization using manometry.
BACKGROUND
Unintended arterial puncture occurs in 2%-4.5% of central venous catheterizations, resulting in arterial injury in 0.1%-0.5% of patients. Routine performance of manometry during catheterization may successfully identify unintended arterial puncture and avoid arterial cannulation and injury.


METHODS
We conducted a retrospective review of all cases of central venous catheter placement during a 15-yr period after implementation of a safety program requiring mandatory use of manometry to verify venous access. Arterial injuries were defined as unintended arterial cannulations with a 7-French or larger catheter or dilator. Arterial punctures were defined as the unintended placement of an 18-gauge catheter or needle into the artery. Data were reviewed for all arterial injuries during the entire 15-yr period. In addition, data on both arterial puncture and subsequent arterial injury were evaluated during the final year of analysis.


RESULTS
A total of 9348 central venous catheters were placed during the observation period. During the full 15 yr of observation, there were no cases of arterial injury. During the final year of assessment, 511 central venous catheters were placed, with arterial punctures in 28 patients (5%). Arterial puncture was recognized without manometry in 24 cases. Arterial puncture was identified only with manometry in 4 cases, with no incidents of arterial injury.


CONCLUSIONS
Consistent use of manometry, to verify venous placement, during central venous catheterization effectively eliminated arterial injury from unintended arterial cannulation during the 15-yr assessment.
Department of Anesthesiology, 3A101, Veterans Affairs Medical Center, University of Pittsburgh School of Medicine, University Dr. C, Pittsburgh, PA 15240, USA. ezaruc@anes.upmc.edu
Catalin S
CS
Ezaru
Michael P
MP
Mangione
Todd M
TM
Oravitz
James W
JW
Ibinson
Richard J
RJ
Bjerke
D001158:Arteries / Q000293:injuries*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies