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Related Experiment Videos

Avoiding complications of long-term venous access

H F Henriques1, R Karmy-Jones, S M Knoll

  • 1Department of Surgery, George Washington University Medical Center, Washington, D.C. 20037.

The American Surgeon
|September 1, 1993
PubMed
Summary

Minimize complications from long-term venous catheters by choosing the right placement. This study recommends single-lumen catheters via the external jugular cutdown route for safer vascular access.

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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.

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  • 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.