Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202300701
Jornal Vascular Brasileiro
Original Article

Complicações de acessos venosos centrais em um serviço de cirurgia vascular de um hospital de ensino: uma coorte prospectiva

Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study

Leonardo Jatczak; Renan Camargo Puton; Alencar Junior Lopes Proença; Leonardo Colussi Rubin; Luiza Brum Borges; Jaber Nashat Saleh; Mateus Picada Corrêa

Downloads: 2
Views: 266

Resumo

Contexto: Os acessos venosos centrais são essenciais no manejo de pacientes hospitalizados; contudo, a sua inserção está sujeita a complicações que podem dificultar seu uso e causar morbidade aos pacientes. No Brasil, dados acerca da incidência dessas complicações e das variáveis associadas com esse desfecho são escassos.

Objetivos: Determinar a incidência de complicações mecânicas e de falhas de acessos venosos centrais de curta permanência realizados no serviço de Cirurgia Vascular de um hospital de ensino, além de identificar as variáveis associadas com a sua ocorrência.

Métodos: Tratou-se de uma coorte prospectiva com 73 tentativas de acesso venoso central realizadas em pacientes assistidos pelo serviço de Cirurgia Vascular de um hospital de ensino entre julho e outubro de 2022.

Resultados: Complicações mecânicas ocorreram em 12 tentativas de acessos (16,44%), e falhas, em 10 tentativas (13,70%). Os fatores associados às complicações mecânicas foram menor experiência do operador (p < 0,001), menor grau de especialização do operador (p = 0,014), falha na tentativa de acesso precedente à solicitação de auxílio ao serviço de Cirurgia Vascular (p = 0,008) e presença de pelo menos dois critérios de dificuldade (p = 0,007).

Conclusões: A incidência local de complicações mecânicas e de falhas dos acessos venosos centrais foi semelhante à descrita na literatura internacional, mas foi superior à descrita em trabalhos brasileiros. Os resultados sugerem que o grau de experiência do executor do acesso, a história de falha em tentativa precedente e a presença de pelo menos dois critérios de dificuldade verificados antes do procedimento estão associados com piores desfechos.

Palavras-chave

dispositivos de acesso vascular, cateteres, complicações pós-operatórias

Abstract

Background: Central venous catheters are essential for management of hospitalized patients, but their insertion is subject to complications that can make them unusable and/or cause patient morbidity. There are few data on the incidence of these complications and the variables associated with these outcomes in Brazil.

Objectives: To determine the incidence of mechanical complications and failures of short stay central venous catheters fitted by the vascular surgery service at a teaching hospital and identify variables associated with their occurrence.

Methods: This was a prospective cohort of 73 attempts to fit patients with a central venous catheter performed by the vascular surgery service at a teaching hospital from July to October of 2022.

Results: Mechanical complications occurred in 12 cannulation attempts (16.44%) and there were 10 failures (13.70%). The factors associated with mechanical complications wereless experienced operators (p < 0.001), less specialized operators (p = 0.014), a failed attempt prior to requesting help from the vascular surgery service (p = 0.008), and presence of at least two criteria for difficulty (p = 0.007).

Conclusions: The local incidence of mechanical complications and central venous cannulation failures was similar to rates described in the international literature, but higher than rates in other Brazilian studies. The results suggest that the degree of experience of the person fitting the catheter, history of a failed prior attempt, and presence of at least two criteria for difficulty identified before the procedure were associated with worse outcomes.

Keywords

vascular access devices; catheters; postoperative complications

References

1 Kissane JL, Hughes JA, Cantwell CP, Waybill PN. 83 - Peripherally inserted central catheters and nontunneled central venous catheters. In: Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Morgan RA, editors. Image-Guided Interventions [Internet]. 3rd ed. Boston: Elsevier; 2020 (Expert Radiology). [citado 2023 abr 23]. p. 669-76.e2. https://www.sciencedirect.com/science/article/pii/B978032361204300083X

2 Edgeworth J. Intravascular catheter infections. J Hosp Infect. 2009;73(4):323-30. http://dx.doi.org/10.1016/j.jhin.2009.05.008. PMid:19699555.

3 Raad I. Intravascular-catheter-related infections. Lancet. 1998;351(9106):893-8. http://dx.doi.org/10.1016/S0140-6736(97)10006-X. PMid:9525387.

4 Brasil. Ministério da Saúde. Departamento de informática do Sistema Único de Saúde - DATASUS. Informações de Saúde (TABNET) - DATASUS [Internet]. Brasília: DATASUS; 2022. [citado 2023 abr 23]. https://datasus.saude.gov.br/informacoes-de-saude-tabnet/

5 Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007;204(4):681-96. http://dx.doi.org/10.1016/j.jamcollsurg.2007.01.039. PMid:17382229.

6 Smith RN, Nolan JP. Central venous catheters. BMJ. 2013;347:f6570. http://dx.doi.org/10.1136/bmj.f6570. PMid:24217269.

7 McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-33. http://dx.doi.org/10.1056/NEJMra011883. PMid:12646670.

8 Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central line catheters and associated complications: a review. Cureus. 2019;11(5):e4717. http://dx.doi.org/10.7759/cureus.4717. PMid:31355077.

9 Bowdle A. Vascular complications of central venous catheter placement: evidence-based methods for prevention and treatment. J Cardiothorac Vasc Anesth. 2014;28(2):358-68. http://dx.doi.org/10.1053/j.jvca.2013.02.027. PMid:24008166.

10 Lennon M, Zaw NN, Pöpping DM, Wenk M. Procedural complications of central venous catheter insertion. Minerva Anestesiol. 2012;78(11):1234-40. PMid:22699699.

11 Yoon H-K, Hur M, Cho H, et al. Effects of practitioner’s experience on the clinical performance of ultrasound-guided central venous catheterization: a randomized trial. Sci Rep. 2021;11(1):6726. http://dx.doi.org/10.1038/s41598-021-86322-y. PMid:33762662.

12 Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med. 1994;331(26):1735-8. http://dx.doi.org/10.1056/NEJM199412293312602. PMid:7984193.

13 Brederlau J, Greim C, Schwemmer U, Haunschmid B, Markus C, Roewer N. Ultrasound-guided cannulation of the internal jugular vein in critically ill patients positioned in 30° dorsal elevation. Eur J Anaesthesiol. 2004 [citado 2023 abr 23];21(9):684-7. https://journals.lww.com/ejanaesthesiology/Fulltext/2004/09000/Ultrasound_guided_cannulation_of_the_internal.3.aspx

14 Hatfield A, Bodenham A. Portable ultrasound for difficult central venous access. Br J Anaesth. 1999;82(6):822-6. http://dx.doi.org/10.1093/bja/82.6.822. PMid:10562772.

15 Hatfield A, Bodenham A. Difficult central venous access and the role of ultrasound. Curr Anaesth Crit Care. 2002;13(4):185-93. http://dx.doi.org/10.1054/cacc.2002.0398.

16 Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med. 2006;21(1):40-6. http://dx.doi.org/10.1177/0885066605280884. PMid:16698743.

17 Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization: failure and complication rates by three percutaneous approaches. Arch Intern Med. 1986;146(2):259-61. http://dx.doi.org/10.1001/archinte.1986.00360140065007. PMid:3947185.

18 Hanauer LPT, Comerlato PH, Papke A, et al. Reducing central vein catheterization complications with a focused educational program: a retrospective cohort study. Sci Rep. 2020;10(1):17530. http://dx.doi.org/10.1038/s41598-020-74395-0. PMid:33067489.

19 Comerlato PH, Rebelatto TF, De Almeida FAS, et al. Complications of central venous catheter insertion in a teaching hospital. Rev Assoc Med Bras. 2017;63(7):613-20. http://dx.doi.org/10.1590/1806-9282.63.07.613. PMid:28977087.

20 Lee YH, Kim TK, Jung YS, et al. Comparison of needle insertion and guidewire placement techniques during internal jugular vein catheterization: the thin-wall introducer needle technique versus the cannula-over-needle technique. Crit Care Med. 2015;43(10):2112-6. http://dx.doi.org/10.1097/CCM.0000000000001167. PMid:26121076.

21 Odendaal J, Kong VY, Sartorius B, Liu TY, Liu YY, Clarke DL. Mechanical complications of central venous catheterisation in trauma patients. Ann R Coll Surg Engl. 2017;99(5):390-3. http://dx.doi.org/10.1308/rcsann.2017.0022. PMid:28462650.

22 Adrian M, Borgquist O, Kröger T, et al. Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study. Br J Anaesth. 2022;129(6):843-50. http://dx.doi.org/10.1016/j.bja.2022.08.036. PMid:36280461.

23 Björkander M, Bentzer P, Schött U, Broman ME, Kander T. Mechanical complications of central venous catheter insertions: A retrospective multicenter study of incidence and risks. Acta Anaesthesiol Scand. 2019;63(1):61-8. http://dx.doi.org/10.1111/aas.13214. PMid:29992634.

24 Calvache J-A, Rodríguez M-V, Trochez A, Klimek M, Stolker R-J, Lesaffre E. Incidence of mechanical complications of central venous catheterization using landmark technique: do not try more than 3 times. J Intensive Care Med. 2016;31(6):397-402. http://dx.doi.org/10.1177/0885066614541407. PMid:24988896.

25 Lathey RK, Jackson RE, Bodenham A, Harper D, Patle V, Anaesthetic Audit and Research Matrix of Yorkshire (AARMY). A multicentre snapshot study of the incidence of serious procedural complications secondary to central venous catheterisation. Anaesthesia. 2017;72(3):328-34. http://dx.doi.org/10.1111/anae.13774. PMid:27981565.

26 Merrer J, De Jonghe B, Golliot F, et al,. Complications of femoral and subclavian venous catheterization in Critically Ill patients: a randomized controlled trial. JAMA. 2001;286(6):700-7. http://dx.doi.org/10.1001/jama.286.6.700. PMid:11495620.

27 Sitzmann JV, Townsend TR, Siler MC, Bartlett JG. Septic and technical complications of central venous catheterization: a prospective study of 200 consecutive patients. Ann Surg. 1985;202(6):766-70. http://dx.doi.org/10.1097/00000658-198512000-00017. PMid:3935062.

28 Schummer W, Schummer C, Rose N, Niesen W-D, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. Intensive Care Med. 2007;33(6):1055-9. http://dx.doi.org/10.1007/s00134-007-0560-z. PMid:17342519.

29 Lefrant J-Y, Muller L, De La Coussaye J-E, et al. Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients. Intensive Care Med. 2002;28(8):1036-41. http://dx.doi.org/10.1007/s00134-002-1364-9. PMid:12185422.

30 Rocha PN, Braga PS, Ritt GF, Gusmão LF, Pontes LCS, Santos MLM. Complicações imediatas relacionadas à inserção de cateteres duplo-lúmen para hemodiálise. Brazilian J Nephrol. 2008 [citado 2023 abr 23];30(1):54-8. https://www.bjnephrology.org/article/complicacoes-imediatas-relacionadas-a-insercao-de-cateteres-duplo-lumen-para-hemodialise/

31 Hind D, Calvert N, McWilliams R, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 2003;327(7411):361. http://dx.doi.org/10.1136/bmj.327.7411.361. PMid:12919984.

32 Taylor RW, Palagiri AV. Central venous catheterization. Crit Care Med. 2007;35(5):1390-6. http://dx.doi.org/10.1097/01.CCM.0000260241.80346.1B. PMid:17414086.

33 Heidemann L, Nathani N, Sagana R, Chopra V, Heung M. A contemporary assessment of mechanical complication rates and trainee perceptions of central venous catheter insertion. J Hosp Med. 2017;12(8):646-51. http://dx.doi.org/10.12788/jhm.2784. PMid:28786431.

34 Kaur R, Mathai AS, Abraham J. Mechanical and infectious complications of central venous catheterizations in a tertiary-level intensive care unit in northern India. Indian J Anaesth. 2012;56(4):376-81. http://dx.doi.org/10.4103/0019-5049.100823. PMid:23087461.
 


Submitted date:
04/23/2023

Accepted date:
06/12/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
650b5745a9539561ef41f4f2 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections