Central venous access by air medical personnel

Vascular access is vital in the resuscitation of critically ill and injured patients for both fluid resuscitation and the delivery of medications. However, peripheral access is not always possible in patients with hypovolemia or difficult anatomy. Central venous access is an alternative vascular access strategy for air medical crews, offering the advantage of relatively predictable anatomy, even in unstable patients. The success and complication rates for the procedure in the hands of flight air medical personnel must be considered in the decision to institute a central venous access procedure.

To explore success and complication rates for central venous access attempts in patients treated by air medical crews.

This was a retrospective review using advanced procedure quality improvement forms. All air medical patients in whom an attempt at central venous access was made over a 30-month period were included. Femoral and subclavian lines were compared for incidence, success rates, and complications.

A total of 50 patients were identified over the 30-month study period. The incidence of femoral and subclavian attempts was approximately equal. The overall success rate was 66% (60% for subclavian, 67% for femoral, and 73% for nonspecified site). The mean number of attempts was 1.2 for each approach. The only reported complication was an arterial placement during a subclavian attempt.

We observed moderate success rates and a low incidence of reported complications with air medical central venous access attempts.