title: Ten years of mechanical complications of central venous catheterization in trauma patients.
abstract: The study purpose was to determine the incidence of mechanical complications (MC) associated with central venous catheterization (CVC) and to evaluate their impact on outcomes. This was a retrospective review of trauma morbidity and mortality records at a Level I trauma center (1999  to 2009). Demographics and outcomes were extracted for all trauma patients with CVC. Patients developing MC were compared with those who did not. Four thousand eight hundred eighteen lines were placed in 2935 patients. Of these, 1.5 per cent (n = 73) had MC. A total of 64.4 per cent (n = 47)  were pneumothoraces followed by arterial cannulation at 8.2 per cent (n = 6) and thrombosis at 6.8 per cent (n = 5). The rate of MC by access site was: subclavian 1.8 per cent (n = 52), internal jugular 1.2 per cent (n = 10), and femoral 0.3 per cent (n = 3) (P value for trend = 0.001).  Change in management was required in 31.5 per cent (n = 23). Number of lines (P < 0.001), Injury Severity Score (P < 0.001), body mass index less than 20 kg/m(2) (P = 0.036), and chest Abbreviated Injury Score greater than 3 (P = 0.034) were significant  predictors of MC. Patients with MC had a longer intensive care unit length of stay (18.8 ± 25.7 vs 11.4 ± 13.3; adjusted odds ratio, 5.75; 95% confidence interval, 2.24-9.25; P = 0.001). Incidence of MC was 1.5 per cent. Complications were clinically significant  in 31.5 per cent and resulted in longer intensive care unit stays.
authors.affiliation: Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California 90033-4225, USA. crystali@usc.edu
authors.forename: Crystal
authors.initials: C
authors.lastname: Ives
authors.forename: Donald
authors.initials: D
authors.lastname: Moe
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Bernardino
authors.initials: B
authors.lastname: Castelo Branco
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Margarita
authors.initials: M
authors.lastname: Bass
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000401:mortality; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology; D014947:Wounds and Injuries / Q000628:therapy*