Eliminating arterial injury during central venous catheterization using manometry.

Area of Science:

• Medical Devices
• Interventional Cardiology
• Patient Safety

Background:

• Unintended arterial puncture complicates 2%-4.5% of central venous catheterizations.
• Arterial injury occurs in 0.1%-0.5% of patients undergoing these procedures.
• Manometry may identify arterial puncture, preventing injury.

Purpose of the Study:

• To evaluate the effectiveness of mandatory manometry in preventing arterial injury during central venous catheterization.

Main Methods:

• Retrospective review of 9348 central venous catheter placements over 15 years.
• Mandatory manometry to verify venous access was implemented as a safety program.
• Arterial injury defined as unintended cannulation with ≥7-French catheter/dilator; arterial puncture as unintended placement of 18-gauge catheter/needle into artery.

Main Results:

• No arterial injuries occurred during the 15-year observation period.
• In the final year, 511 catheterizations included 28 arterial punctures (5%).
• Manometry identified 4 punctures missed by other methods, with no resulting injuries.

Conclusions:

• Consistent use of manometry during central venous catheterization eliminated arterial injury.
• Manometry is an effective tool for verifying venous placement and preventing arterial complications.