Anaesthesia and Intensive Care, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden; Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.
Anaesthesia and Intensive Care, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden; Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.
Br J Anaesth. 2022 Dec;129(6):843-850. doi: 10.1016/j.bja.2022.08.036. Epub 2022 Oct 22.
Limited data are available on the incidence of mechanical complications after ultrasound-guided central venous catheterisation. We aimed to determine the incidence of mechanical complications in hospitals where real-time ultrasound guidance is clinical practice for central venous access and to identify variables associated with mechanical complications.
All central venous catheter insertions in patients ≥16 yr at four emergency care hospitals in Sweden from March 2, 2019 to December 31, 2020 were eligible for inclusion. Every insertion was monitored for complete documentation and occurrence of mechanical complications within 24 h after catheterisation. Multivariable logistic regression analyses were used to determine associations between predefined variables and mechanical complications.
In total, 12 667 catheter insertions in 8586 patients were included. The incidence (95% confidence interval [CI]) of mechanical complications was 7.7% (7.3-8.2%), of which 0.4% (0.3-0.5%) were major complications. The multivariable analyses showed that patient BMI <20 kg m (odds ratio 2.69 [95% CI: 1.17-5.62]), male operator gender (3.33 [1.60-7.38]), limited operator experience (3.11 [1.64-5.77]), and increasing number of skin punctures (2.18 [1.59-2.88]) were associated with major mechanical complication. Subclavian vein catheterisation was associated with pneumothorax (5.91 [2.13-17.26]).
The incidence of major mechanical complications is low in hospitals where real-time ultrasound guidance is the standard of care for central venous access. Several variables independently associated with mechanical complications can be used for risk stratification before catheterisation procedures, which might further reduce complication rates.
NCT03782324.
超声引导下中心静脉置管后机械并发症的发生率数据有限。本研究旨在确定在实时超声引导为中心静脉通路临床实践的医院中机械并发症的发生率，并确定与机械并发症相关的变量。
2019 年 3 月 2 日至 2020 年 12 月 31 日，瑞典四家急诊医院符合条件的 16 岁及以上患者的所有中心静脉置管均纳入研究。每一次置管均进行了全面的置管记录，并在置管后 24 小时内监测机械并发症的发生情况。多变量逻辑回归分析用于确定预设变量与机械并发症之间的关联。
共纳入 8586 例患者的 12667 次置管。机械并发症的发生率（95%置信区间[CI]）为 7.7%（7.3-8.2%），其中 0.4%（0.3-0.5%）为严重并发症。多变量分析显示，患者 BMI<20kg/m2（比值比 2.69[95%CI：1.17-5.62]）、男性操作者性别（3.33[1.60-7.38]）、操作者经验有限（3.11[1.64-5.77]）和皮肤穿刺次数增加（2.18[1.59-2.88]）与严重机械并发症相关。锁骨下静脉置管与气胸有关（5.91[2.13-17.26]）。
在实时超声引导为中心静脉通路标准护理的医院中，严重机械并发症的发生率较低。一些与机械并发症独立相关的变量可用于置管前的风险分层，这可能进一步降低并发症发生率。
NCT03782324。
