title: A retrospective clinical audit of 696 central venous catheterizations at a tertiary care teaching hospital in India.
abstract: BACKGROUND
  Malpositions after central venous cannulation are frequently encountered and may need a change in catheter. The incidence of malpositions are varied according to various studies and depend on the experience of the operator performing the cannulation.
  
  
  OBJECTIVE
  To access the incidence of malpositions and related complications associated with landmark-guided central venous cannulation in a 15-bedded medical surgical ICU over a period of three years.
  
  
  METHODS
  Retrospective analysis of records of all the central venous cannulation done in a 15- bedded medical- surgical ICU over the period of three years (April 2008 to June 2011) were evaluated for the site and side of insertion, number of attempts of puncture, arterial puncture as well as the malpositions on post procedural chest X-ray. The records were also evaluated for the experience of the operator performing cannulation and relationship between experience of operator to malpositions of catheter.
  
  
  METHODS
  Analysis was done using SPSS v 17.0 for Windows. Chi-square test was applied to evaluate the statistical significance. P > 0.05 was significant.
  
  
  RESULTS
  Records of 696 cannulations were evaluated. Malpositions occurred in 40 patients. Subclavian vein cannulation resulted in increased malpositions in relation to internal jugular vein cannulation. More common with left sided cannulation. Experience of operator had positive correlation with malpositions and arterial puncture. Arterial puncture was common in 6%, while more than one attempt for cannulation was taken in 100 patients.
  
  
  CONCLUSIONS
  Incidence of malpositions was low. We conclude that experience of operator improves successful catheterization with lesser number of complications.
authors.affiliation: Department of Anaesthesiology Intensive Care and Pain Management, Himalayan Institute of Medical Sciences, HIHT University, Dehradun, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Agrawal
authors.forename: Yashwant S
authors.initials: YS
authors.lastname: Payal
authors.forename: Jagdish P
authors.initials: JP
authors.lastname: Sharma