Avoiding complications of long-term venous access

Area of Science:

• Vascular Surgery
• Medical Devices
• Patient Safety

Background:

• Indwelling venous catheters are essential for long-term treatments like chemotherapy and antibiotics.
• However, catheter placement and prolonged use can lead to significant complications.
• Developing guidelines to minimize these risks is crucial for patient care.

Purpose of the Study:

• To establish guidelines for reducing complications associated with long-term indwelling venous catheters.
• To analyze the impact of different catheter placement routes and types on complication rates.

Main Methods:

• Prospective recording of complications for 355 catheters placed in 297 patients.
• Evaluation of four placement routes: subclavian, external jugular cutdown, internal jugular cutdown, and cephalic vein cutdown.
• Statistical analysis of complication rates, including malposition, pneumothorax, thrombosis, and sepsis, in relation to placement method and catheter characteristics.

Main Results:

• Catheter malposition occurred in 5.2% of cases, irrespective of the placement route.
• Pneumothorax was exclusively observed with the subclavian approach (5.6%).
• Axillary vein thrombosis was more frequent with subclavian (10.3%) versus external jugular (2.3%) or cephalic (2.3%) vein placement (P < 0.05).
• Line sepsis occurred in 28 instances, significantly associated with abnormal white blood count and double-lumen catheters (18.4% vs. 4.4%, P < 0.01).

Conclusions:

• The morbidity of long-term venous catheters is significantly influenced by the placement route, number of lumens, and pre-placement white blood count.
• Recommend single-lumen catheter placement via the external jugular cutdown route to minimize complications whenever feasible.