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Indications, Management, and Complications of Percutaneous Subclavian Catheters: An Audit

Indications, Management, and Complications of Percutaneous Subclavian Catheters: An Audit Abstract • A retrospective outcome-oriented audit was conducted to determine the complications associated with percutaneous infraclavicular subclavian catheters in a university hospital. The study is unique since patients having these catheters were not under the care of a select group of physicians and the patients were not restricted to a special nursing unit. One hundred and seventeen catheters were placed in 68 patients. Seventeen types of complications were audited. There were 13 complications (11%) identified as follows: pneumothorax, seven; subcutaneous emphysema, one; subclavian artery hematoma, one; pleural effusion, one; improper position, two; and sepsis, one. No mortality was associated with catheter placement. Pattern analysis suggested physician inexperience as an important cause of complications. The difficulties of establishing a retrospective audit based on documentation errors and omissions are discussed. (Arch Surg 113:1421-1425, 1978) References 1. Dudrick SJ, Wilmore DW, Vars HM, et al: Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? Ann Surg 169:974-984, 1969.Crossref 2. Wilmore DW, Dudrick SJ: Safe long-term venous catheterization . Arch Surg 98:256-258, 1969.Crossref 3. Wilson JN, Grow JB, Demong CV, et al: Central venous pressure in optimal blood volume maintenance . Arch Surg 85:563-578, 1962.Crossref 4. Borja AR: Current status of infraclavicular subclavian vein catheterization . Ann Thorac Surg 13:615-624, 1972.Crossref 5. The PEP Primer: Performance Evaluation Procedure for Auditing and Improving Patient Care . Chicago, Joint Commission on Accreditation of Hospitals, 1974. 6. International Classification of Diseases , ed 8. US Department of Health, Education, and Welfare, Public Health Service No. (1693) , 1968, vol 1 and 2. 7. Smith BE, Modell JH, Gaub ML, et al: Complications of subclavian vein catheterization . Arch Surg 90:228-229, 1965.Crossref 8. Adar R, Mozes M: Hydromediastinum . JAMA 214:372, 1970.Crossref 9. Buchman RJ: Subclavian venipuncture . Milit Med 134:451-453, 1969. 10. Flanagan JP, Gradisar IV, Gross RJ, et al: Air embolus: A lethal complication of subclavian venipuncture . N Engl J Med 281:488-489, 1969.Crossref 11. Grace DM: Air embolism with neurologic complications: A potential hazard of central venous catheters . Can J Surg 20:51-53, 1977. 12. Obel IWP: Transient phrenic-nerve paralysis following subclavian venipuncture . Anesthesiology 33:369-370, 1970.Crossref 13. Vellani CW, Tildesley G, Davies LG: Endocardial pacing: A percutaneous method using the subclavian vein . Br Heart J 31:106-111, 1969.Crossref 14. Faden H, Durham G, Tinker J, et al: Septic thrombosis following subclavian vein catheterization . J Pediatr 88:895-896, 1976.Crossref 15. Mogil RA, DeLaurentis DA, Rosemond GP: The infraclavicular venipuncture . Arch Surg 95:320-324, 1967.Crossref 16. Defalque RJ: The subclavian route . Anaesthesist 21:325-335, 1972. 17. Voegele LD: Routine subclavian vein catheterization in abdominal surgical practice . Am J Surg 131:178-180, 1976.Crossref 18. Ryan JA Jr, Abel RM, Abbott WM, et al: Catheter complications in total parenteral nutrition . N Engl J Med 290:757-761, 1974.Crossref 19. Fischer J, Lundstrom J, Ottander HG: Central venous cannulation: A radiological determination of catheter positions and immediate intrathoracic complications . Acta Anaesth Scand 21:45-49, 1977.Crossref 20. Bernard RW, Stahl WM: Subclavian vein catheterizations: A prospective study: I. Non-infectious complications . Ann Surg 173:184-190, 1971.Crossref 21. Sorensen TIA, Sonne-Holm S: Central venous catheterization through the basilic vein or by infraclavicular puncture? Acta Chir Scand 141:323-325, 1975. 22. Longerbeam JK, Vannix R, Wagner W, et al: Central venous pressure monitoring . Am J Surg 110:220-230, 1965.Crossref 23. Deitel M, McIntyre JA: Radiographic confirmation of site of central venous pressure catheters . Can J Surg 14:42-52, 1971. 24. Bernard RW, Stahl WM, Chase RM Jr: Subclavian vein catheterizations: A prospective study: II. Infectious complications . Ann Surg 173:191-200, 1971.Crossref 25. Copeland EM III, MacFadyen BV Jr, McGown C, et al: The use of hyperalimentation in patients with potential sepsis . Surg Gynecol Obstet 138:377-380, 1974. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Indications, Management, and Complications of Percutaneous Subclavian Catheters: An Audit

Archives of Surgery , Volume 113 (12) – Dec 1, 1978

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1978.01370240043006
Publisher site
See Article on Publisher Site

Abstract

Abstract • A retrospective outcome-oriented audit was conducted to determine the complications associated with percutaneous infraclavicular subclavian catheters in a university hospital. The study is unique since patients having these catheters were not under the care of a select group of physicians and the patients were not restricted to a special nursing unit. One hundred and seventeen catheters were placed in 68 patients. Seventeen types of complications were audited. There were 13 complications (11%) identified as follows: pneumothorax, seven; subcutaneous emphysema, one; subclavian artery hematoma, one; pleural effusion, one; improper position, two; and sepsis, one. No mortality was associated with catheter placement. Pattern analysis suggested physician inexperience as an important cause of complications. The difficulties of establishing a retrospective audit based on documentation errors and omissions are discussed. (Arch Surg 113:1421-1425, 1978) References 1. Dudrick SJ, Wilmore DW, Vars HM, et al: Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? Ann Surg 169:974-984, 1969.Crossref 2. Wilmore DW, Dudrick SJ: Safe long-term venous catheterization . Arch Surg 98:256-258, 1969.Crossref 3. Wilson JN, Grow JB, Demong CV, et al: Central venous pressure in optimal blood volume maintenance . Arch Surg 85:563-578, 1962.Crossref 4. Borja AR: Current status of infraclavicular subclavian vein catheterization . Ann Thorac Surg 13:615-624, 1972.Crossref 5. The PEP Primer: Performance Evaluation Procedure for Auditing and Improving Patient Care . Chicago, Joint Commission on Accreditation of Hospitals, 1974. 6. International Classification of Diseases , ed 8. US Department of Health, Education, and Welfare, Public Health Service No. (1693) , 1968, vol 1 and 2. 7. Smith BE, Modell JH, Gaub ML, et al: Complications of subclavian vein catheterization . Arch Surg 90:228-229, 1965.Crossref 8. Adar R, Mozes M: Hydromediastinum . JAMA 214:372, 1970.Crossref 9. Buchman RJ: Subclavian venipuncture . Milit Med 134:451-453, 1969. 10. Flanagan JP, Gradisar IV, Gross RJ, et al: Air embolus: A lethal complication of subclavian venipuncture . N Engl J Med 281:488-489, 1969.Crossref 11. Grace DM: Air embolism with neurologic complications: A potential hazard of central venous catheters . Can J Surg 20:51-53, 1977. 12. Obel IWP: Transient phrenic-nerve paralysis following subclavian venipuncture . Anesthesiology 33:369-370, 1970.Crossref 13. Vellani CW, Tildesley G, Davies LG: Endocardial pacing: A percutaneous method using the subclavian vein . Br Heart J 31:106-111, 1969.Crossref 14. Faden H, Durham G, Tinker J, et al: Septic thrombosis following subclavian vein catheterization . J Pediatr 88:895-896, 1976.Crossref 15. Mogil RA, DeLaurentis DA, Rosemond GP: The infraclavicular venipuncture . Arch Surg 95:320-324, 1967.Crossref 16. Defalque RJ: The subclavian route . Anaesthesist 21:325-335, 1972. 17. Voegele LD: Routine subclavian vein catheterization in abdominal surgical practice . Am J Surg 131:178-180, 1976.Crossref 18. Ryan JA Jr, Abel RM, Abbott WM, et al: Catheter complications in total parenteral nutrition . N Engl J Med 290:757-761, 1974.Crossref 19. Fischer J, Lundstrom J, Ottander HG: Central venous cannulation: A radiological determination of catheter positions and immediate intrathoracic complications . Acta Anaesth Scand 21:45-49, 1977.Crossref 20. Bernard RW, Stahl WM: Subclavian vein catheterizations: A prospective study: I. Non-infectious complications . Ann Surg 173:184-190, 1971.Crossref 21. Sorensen TIA, Sonne-Holm S: Central venous catheterization through the basilic vein or by infraclavicular puncture? Acta Chir Scand 141:323-325, 1975. 22. Longerbeam JK, Vannix R, Wagner W, et al: Central venous pressure monitoring . Am J Surg 110:220-230, 1965.Crossref 23. Deitel M, McIntyre JA: Radiographic confirmation of site of central venous pressure catheters . Can J Surg 14:42-52, 1971. 24. Bernard RW, Stahl WM, Chase RM Jr: Subclavian vein catheterizations: A prospective study: II. Infectious complications . Ann Surg 173:191-200, 1971.Crossref 25. Copeland EM III, MacFadyen BV Jr, McGown C, et al: The use of hyperalimentation in patients with potential sepsis . Surg Gynecol Obstet 138:377-380, 1974.

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1978

References