Subclavian central venous catheter, complications at insertion

Area of Science:

• Medical Procedures
• Vascular Access
• Patient Safety

Background:

• Central venous catheters (CVCs) are vital for critically ill patients needing hemodynamic monitoring, vasopressor support, parenteral nutrition, or chemotherapy.
• Subclavian CVC placement carries risks of severe, potentially fatal complications.
• Ultrasonographic guidance is often used to mitigate these risks.

Purpose of the Study:

• To evaluate the success rate of central venous catheter (CVC) placement without ultrasonographic guidance.
• To determine the incidence and types of complications associated with subclavian CVC insertion.
• To assess the safety and efficacy of non-ultrasound-guided CVC placement.

Main Methods:

• Retrospective cohort study at Hospital de Especialidades del Centro Médico Nacional Siglo XXI.
• Inclusion of all patients undergoing CVC placement.
• Data collection on indications, insertion site, duration, withdrawal reasons, and complication details.

Main Results:

• 283 patients (aged 16-95) were studied; 55% had prior catheterizations.
• Previous catheterization history did not correlate with increased complications.
• Common indications included parenteral nutrition, preoperative support, critical illness, chemotherapy, and plasmapheresis.

Conclusions:

• Subclavian CVC placement by trained personnel, even without ultrasound, is safe and effective.
• Success rates approach 100%, with severe complications under 2% and zero mortality.
• Limiting insertion attempts to two significantly reduces morbidity.