Prospective Study on Success and Complication Rate of Central Venous Catheterization in a University-affiliated Hospital

Bae, Chang Hwang; Kim, Woo Kun; Park, Wan; Park, Jin Hee; Kim, Jeong Kyun; Choi, Sung Jun; Lee, Je Hwan; Kim, Sung Bae; Kim, Sang We; Suh, Cheolwon; Lee, Kyoo Hyung; Lee, Jung Shin; Koh, Younsuck; Sung, Kyu Bo; Kim, Sang Hee

Abstract

OBJECTIVES
The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study.
METHODS
Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hematology/ oncology Department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, ID numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5 categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others.
RESULTS
The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4 performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%.
CONCLUSION
The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4 times at initial trial.