Percutaneous central venous catheterization performed by medical house officers: a prospective study.

We prospectively determined the complications of percutaneous central venous catheterizations performed by medical house officers in 302 patients. We also analyzed the factors affecting the success and complication rates of such invasive procedures. The central vein was successfully catheterized in 363 (77%) of 470 attempts. The internal jugular and subclavian vein approaches were significantly more successful (86%) than the external jugular vein approach (61%, P less than 0.001 by chi 2). The success rate improved significantly when catheterization was attempted under elective circumstances (P less than 0.003) and also after the vein was initially located with a small-gauge needle (P less than 0.001). Our results suggest that efforts should be abandoned after the third unsuccessful pass with a large-gauge needle in the same site. Complications of catheter insertion included bleeding (ten patients), hematoma (15 patients), inadvertent arterial punctures (14 patients), iatrogenic pleural effusions (four patients), and pneumothoraces (eight patients). No complications appeared to have a major adverse effect on a patient's clinical course. The inexperienced operator (fewer than 25 prior catheterizations) has a success rate equal to that of the more experienced operator (more than 25 prior catheterizations), but he may be more likely to produce a complication. Medical house officers can perform percutaneous central venous catheterizations with a high rate of success and a low risk to the patient.