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- Title
Risk Factors for Acute Adverse Events During Ultrasound-guided Central Venous Cannulation in the Emergency Department.
- Authors
Theodoro, Daniel; Krauss, Missy; Kollef, Marin; Evanoff, Bradley
- Abstract
Background: Ultrasound (US) greatly facilitates cannulation of the internal jugular vein. Despite the ability to visualize the needle and anatomy, adverse events still occur. The authors hypothesized that the technique has limitations among certain patients and clinical scenarios. Objectives: The purpose of this study was to identify characteristics of adverse events surrounding US-guided central venous cannulation (CVC). Methods: The authors assembled a prospective observational cohort of emergency department (ED) patients undergoing consecutive internal jugular CVC with US. The primary outcome of interest was a composite of acute mechanical adverse events including hematoma, arterial cannulation, pneumothorax, and unsuccessful placement. Physicians performing the CVC recorded anatomical site, reason for insertion, and acute complications. The patients with catheters were followed until the catheters were removed based on radiographic evidence or hospital nursing records. ED charts and pharmacy records contributed variables of interest. A self-reported online survey provided physician experience information. Logistic regression was used to calculate the odds of an adverse outcome. Results: Physicians attempted 289 CVCs on 282 patients. An adverse outcome occurred in 57 attempts (19.7%, 95% confidence interval [CI] = 15.5 to 24.7), the most common being 31 unsuccessful placements (11%, 95% CI = 7.7 to 14.8). Patients with a history of end-stage renal disease (odds ratio [OR] = 3.54, 95% CI = 1.59 to 7.89), and central lines placed by operators with intermediate experience (OR = 2.26, 95% CI = 1.19 to 4.32), were most likely to encounter adverse events. Previously cited predictors such as body mass index (BMI), coagulopathy, and pulmonary hyperinflation were not significant in our final model. Conclusions: Acute adverse events occurred in approximately one-fifth of US-guided internal jugular central line attempts. The study identified both patient (history of end-stage renal disease) and physician (intermediate experience level) factors that are associated with acute adverse events. ACADEMIC EMERGENCY MEDICINE 2010; 17:1055-1061 © 2010 by the Society for Academic Emergency Medicine
- Subjects
CHI-squared test; CLINICAL competence; CONFIDENCE intervals; EMERGENCY medical services; EMERGENCY physicians; EMPLOYEES; EPIDEMIOLOGY; EXPERIENCE; FISHER exact test; HOSPITAL medical staff; JUGULAR vein; LONGITUDINAL method; MEDICAL errors; HEALTH outcome assessment; PATIENTS; PHYSICAL diagnosis; PROBABILITY theory; RESEARCH funding; STATISTICS; T-test (Statistics); U-statistics; ULTRASONIC imaging; COMORBIDITY; DATA analysis; BODY mass index; TREATMENT effectiveness; RETROSPECTIVE studies; RECEIVER operating characteristic curves; CENTRAL venous catheterization; CENTRAL venous catheters; DISEASE risk factors; DRUG side effects
- Publication
Academic Emergency Medicine, 2010, Vol 17, Issue 10, p1055
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/j.1553-2712.2010.00886.x