The American surgeon
-
The American surgeon · Feb 1999
A reevaluation of the radiographically detectable complications of percutaneous venous access lines inserted by four subcutaneous approaches.
As a result of prior studies elucidating the potential complications associated with the use of central venous access lines, the Food and Drug Administration and the manufacturers themselves have published guidelines and warnings outlining these dangers and describing the safest insertion techniques. We will attempt to determine whether this improved education has altered the number and type of complications, comparing the results from different types of hospitals, among the various medical services and among operators with varying degrees of experience. This is a prospective analysis of all central venous pressure (CVP) and Swanz-Ganz catheters (SGCs) inserted between July 1, 1995, and February 30, 1996, at a regional Veteran's Affairs hospital and an inner city university medical center. ⋯ Venous access catheter tip malpositions are very common in all settings, but easily recognized by radiography, whereas PTXs are unusual. In contrast to most older studies, PTXs are more frequently observed with internal jugular as opposed to subclavian cannulations and with SGCs rather than CVP lines. However, our data support prior studies that the right atrium and distal right lower lobe pulmonary artery are the most common sites for CVP and SGC misplacement, respectively, and that there is an improvement in success rates with increasing operator experience.