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Long-term central venous catheters: size and location do matter

Raymond P Onders1, Robert R Shenk, Thomas A Stellato

  • 1Department of Surgery, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA. Raymond.onders@uhhs.com

American Journal of Surgery
|February 24, 2006
PubMed

Insights

For subclavian vein catheterization, using the left side and smaller catheters reduces technical difficulties. This study analyzed 230 long-term central venous catheters to optimize placement procedures.

Area of Science:

  • Vascular access procedures
  • Medical device placement
  • Patient safety in interventional radiology

Background:

  • Optimal placement strategies for long-term central venous catheters, specifically subclavian vein catheterization, remain incompletely defined.
  • Factors such as side of insertion (right vs. left) and catheter size require further analysis.

Purpose of the Study:

  • To evaluate the impact of subclavian vein catheterization side and catheter size on technical difficulty and complications.
  • To identify optimal practices for long-term central catheter placement.

Main Methods:

  • Retrospective review of 502 consecutive central venous catheter placements, with detailed analysis of 230 subclavian vein tunneled catheters.
  • Technical difficulties were systematically defined and recorded, including arterial puncture, malposition, and access site issues.

Main Results:

  • Overall complication rate was low (1%), with technical difficulties in 15% of cases.
  • Larger, triple-lumen catheters showed significantly higher difficulty rates (31%) compared to smaller, single-lumen catheters (11%).
  • Right subclavian placement had a higher technical difficulty rate (24.4%) than left subclavian placement (10.4%).

Conclusions:

  • Left subclavian vein catheterization is associated with fewer technical difficulties.
  • Utilizing the smallest feasible catheter size is recommended to minimize procedural challenges.
Abstract

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