Chronic central venous catheters (CCVC) provide prompt intravenous access in sub-acute care unit patients with a high infection risk. Phlebosclerosis precludes insertion of peripheral venous lines. Many drugs are infused via central route only. Percutaneous central lines are considered high complication risk due to tracheostomy, oro-tracheal secretions and urinary-fecal incontinence.
We retrospectively reviewed records of 107 operative procedures regarding insertion or removal of CCVC done over 5 years in a 50-bed subacute unit. Data abstracted included total number of procedures, indications and complications. The recommendation regarding use of CCVC was made based on clinical rationale and risk versus benefit analysis.
A total N = 66 catheters were placed via subclavian route. The most common use was intravenous antibiotic therapy and blood draws. The most important use was emergent intravenous fluid resuscitation for hypotension. Fifteen percent (10/66) were used for emergency drugs. There were 21 catheters (32%) suspected as a source of infection; 15 of these were removed. Catheter site cellulites developed in six patients. Fifteen catheters (23 %) were blocked either due to blood clots or precipitation of medications. Poor technique in accessing the catheter caused clinically significant hematoma in three (5%) patients. Two patients (3%) developed thrombosis of the subclavian vein. Only one catheter migrated in to the right ventricle. No poor patient outcome was noted secondary to the CCVC. In case of infected catheters antibiotic therapy was attempted to salvage the catheter. Flushing of the obstructed catheter with saline for 24 hours was successful in re-establishing the patency. Five catheters required thrombolytic therapy. Catheters were removed due to infection, obstruction and at patient discharge.
We documented a 32% infection rate, a 23% obstruction rate and a thrombosis rate of 3%. Scheduled in-service training for accessing the catheters may eliminate many complications.
We recommend use of CCVC in sub-acute unit setting due to the clinical rationale. The complication rates are acceptable compared to their usefulness.
D.K. Shrivastava, None.