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Failure and Complication Rates by Three Percutaneous Approaches

J. Iasha Sznajder, MD; Fabio R. Zveibil, MD; Haim Bitterman, MD; Paltiel Weiner, MD; Simon Bursztein, MD

Arch Intern Med. 1986;146(2):259-261.

Abstract
• We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients.

(Arch Intern Med 1986;146:259-261)

Author Affiliations
From the Department of Intensive Care Medicine, Rambam Medical Center, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa. Dr Zveibil is now with the Intensive Care Unit, Naharya (Israel) Hospital, Section of Pulmonary and Critical Care Medicine. Dr Sznajder is now with the Department of Medicine, University of Chicago.

Footnotes
Accepted for publication May 3, 1985.

Read in part at the 13th International Congress of the Israel Society of Anesthesiologists, Jerusalem, Nov 13, 1983.

Reprint requests to Department of Medicine, Box 83, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 (Dr Sznajder).

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