Mechanical Complications Following Central Venous Catheterisation in A Tertiary Care Teaching Institute: A Prospective Observational Study

Abstract

Background: Central venous catheters are an indispensable
component of current day critical care and are employed
for various indications. Central venous catheterizations
(landmark-based or ultrasound-guided) are associated with
mechanical complications. This study aimed to assess, analyze
and compare the complication rate between two commonly
employed catheterization routes: Internal jugular vein and
subclavian vein.
Methodology: A prospective, observational study comparing
two landmark-based central venous catheterization techniques
was planned in a tertiary care teaching institute. 100 patients
requiring central venous catheterizations were enrolled
alternately into the IJV and Subclavian groups. Standard
landmark-based insertion techniques were employed under
strict asepsis. All patients were observed for mechanical
complications in the first 24 hours following catheterization.
Statistical analysis was done using the statistical package
SPSS 20.0. Data were expressed as either mean and standard
deviation or numbers and percentages. Categorical variables
were analyzed using proportions and percentages. Association
between categorical variables was established by Chi-square
and odds ratio (OR) with 95% confidence intervals (CI).
Results: There were 22 complications observed. Incidence of
complications was higher in the IJV group with 17 complications
versus 5 in Subclavian group. There were 4 major complications
and 18 minor complications between the two groups. Major
complications comprised of hematoma formation (7/22) and
arterial puncture (8/22). Incidence of complication was also
analyzed with regards to independent variables.
Conclusion: Mechanical complications following central
venous catheterizations was found in both groups studied.
Internal jugular venous group had a higher mechanical
complication rate than the subclavian group. Ultrasound
guidance and greater detail in delineating the anatomy are
likely to reduce the complication rates.