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Risks of CVCs

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Fred Trayers

on 7 May 2010

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Transcript of Risks of CVCs

Risks of Central Venous Catheters Fred Trayers
LCDR MC USN
Emergency Medicine Resident (PGY-3)
Naval Medical Center, San Diego A Razor Thin Line between Success and Failure Risks of Central Venous Catheters A Risky Proposition What are the Risks? Arterial Puncture
Hematoma
Pneumothorax
Malposition Infection Mechanical Thrombosis Choice of CVC Sites Clinical Question: What is the best choice for the placement of central venous catheters? Search Strategy What is the best choice for the placement of central venous catheters? Clinical Question: Our Choices Risk of Infection Prospective, Observational Study
510 Patients, 4040 catheter days Site Rate HR
Internal Jugular 0.7 2.82
Subclavian 0.0 1.0
Femoral 0.67 1.39 Gowardman. Influence of insertion site on CVC colonization and bloodstream infection rates. Intensive Care Medicine (2008) Pros Pros:
Ease of Access
Low infection risk
Ultrasound Guidance

Cons:
Risk of arterial puncture
Body habitus may preclude access Pros:
Low infection risk
Low risk of displacement

Cons:
Can't use ultrasound
Risk of pneumothorax Pros:
Ease of Access
Ultrasound Guidance

Cons:
High Risk of infection
Body habitus may preclude access Lorente L. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Critical Care (2005) Prospective, Observational Study
2,018 Patients, 18,999 catheter days Site Rate p
Internal Jugular 2.99 0.005 (Sub.)
Subclavian 0.97 -
Femoral 8.34 0.002, 0.001 (IJ/Sub.) Use a subclavian site (rather than a jugular or a femoral site) in adult patients to minimize infection risk for nontunneled CVC placement (Category IA) CDC Recommendation:
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