Wong Adrian Vk, Arora Nitin, Olusanya Olusegun, Sharif Ben, Lundin Robert M, Dhadda A, Clarke S, Siviter R, Argent M, Denton Gavin, Dennis Anna, Day Angela, Szakmany Tamas
Oxford University Hospitals NHS Foundation Trust, UK.
Heart of England NHS Foundation Trust, Birmingham, UK.
J Intensive Care Soc. 2018 Feb;19(1):19-25. doi: 10.1177/1751143717722914. Epub 2017 Aug 21.
Central venous catheters are inserted ubiquitously in critical care and have roles in drug administration, fluid management and renal replacement therapy. They are also associated with numerous complications. The true number of central venous catheters inserted per year and the proportion of them associated with complications are unknown in the UK.
We performed a prospective audit at five hospitals, as a feasibility pilot for a larger, nationwide audit. Using a novel secure online data collection platform, developed earlier and adapted for this project, all central venous catheters inserted for patients admitted to the Intensive Care Units were documented at five pilot sites across the UK.
A total of 117 data collection forms were submitted. Users found the electronic data collection system easy to use. All data fields were ready for analysis immediately after data input. Out of the 117 central venous catheters, 17 were haemodialysis catheters and five pulmonary artery introducers. Experienced practitioners (at least three years' experience) inserted 85% of the central venous catheters. The site of insertion was the internal jugular vein for 80%, femoral for 12% and subclavian for 8% of central venous catheters. Most central venous catheters were inserted in ICU (49%) or theatres (42%). Ultrasound was used for 109 (93%) of central venous catheter insertions and its use was not associated with fewer complications. In 15 cases venopuncture was attempted more than once (all with ultrasound) and this was associated with significantly increased risk of complications. There were eight immediate complications (6.8%): five related to venopuncture and inability to pass a guidewire, two carotid artery punctures and one associated with significant arrhythmia.
This study demonstrates the ease and feasibility of collecting detailed descriptive data on central line insertion and its immediate complications in the UK over two weeks. In our proposed nationwide audit, organisation-level data on local policies and standard operating procedures is required to complete the picture on this important aspect of intensive care practice.
中心静脉导管在重症监护中广泛使用，用于药物输注、液体管理及肾脏替代治疗。它们也与多种并发症相关。在英国，每年插入的中心静脉导管的实际数量以及与之相关的并发症比例尚不清楚。
我们在五家医院进行了一项前瞻性审计，作为一项更大规模的全国性审计的可行性试点。使用一个早期开发并针对本项目进行了调整的新型安全在线数据收集平台，在英国的五个试点地点记录了所有为入住重症监护病房的患者插入的中心静脉导管。
共提交了117份数据收集表。用户发现电子数据收集系统易于使用。所有数据字段在输入数据后即可立即进行分析。在117根中心静脉导管中，17根是血液透析导管，5根是肺动脉导管。经验丰富的从业者（至少有三年经验）插入了85%的中心静脉导管。中心静脉导管的插入部位为颈内静脉的占80%，股静脉的占12%，锁骨下静脉的占8%。大多数中心静脉导管插入于重症监护病房（49%）或手术室（42%）。109例（93%）中心静脉导管插入使用了超声，其使用与较少的并发症无关。在15例中，静脉穿刺尝试了不止一次（均使用超声），这与并发症风险显著增加相关。有8例即刻并发症（6.8%）：5例与静脉穿刺及导丝无法通过有关，2例为颈动脉穿刺，1例与严重心律失常有关。
本研究表明，在英国，在两周内收集关于中心静脉导管插入及其即刻并发症的详细描述性数据是容易且可行的。在我们提议的全国性审计中，需要关于当地政策和标准操作程序的组织层面数据，以完善重症监护实践这一重要方面的情况。
