Preventing Complications of Central Venous Catheterization

• Published in: The New England journal of medicine Vol. 348; no. 12; pp. 1123 - 1133
• Main Authors: McGee, David C, Gould, Michael K
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 20-03-2003
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Infective Agents - therapeutic use; Arteries - injuries; Biological and medical sciences; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheterization, Central Venous - methods; Catheters; Embolism, Air - etiology; Embolism, Air - prevention & control; Emergency and intensive care: techniques, logistics; Health care delivery; Humans; Intensive care medicine; Medical sciences; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Prevention; Sepsis - etiology; Sepsis - therapy; Side effects; Thrombosis - etiology; Thrombosis - prevention & control; Human; Catheterization; Cardiovascular disease; Thrombosis; Central vein; Venous disease; Vascular disease; Infection; Prevention; Complication; Technique; Vein; Resuscitation
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMra011883

Central venous catheters permit the measurement of hemodynamic variables that cannot be measured accurately by noninvasive means. They also allow delivery of medications and nutritional support. More than 15 percent of patients, however, have a serious mechanical, infectious, or thrombotic complication related to the use of a central venous catheter. This review explains strategies for minimizing the frequency of such complications. An accompanying video shows techniques for catheter insertion by the internal jugular and subclavian routes.
A video shows techniques for catheter insertion.
In the United States, physicians insert more than 5 million central venous catheters every year.
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Central venous catheters allow measurement of hemodynamic variables that cannot be measured accurately by noninvasive means and allow delivery of medications and nutritional support that cannot be given safely through peripheral venous catheters. Unfortunately, the use of central venous catheters is associated with adverse events that are both hazardous to patients and expensive to treat.
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More than 15 percent of patients who receive these catheters have complications.
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Mechanical complications are reported to occur in 5 to 19 percent of patients,
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infectious . . .