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      Intravascular Complications of Central Venous Catheterization by Insertion Site.

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          Abstract

          Three anatomical sites are commonly used to insert central venous catheters, but insertion at each site has the potential for major complications.

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          Preventing complications of central venous catheterization.

          David C. McGee, Michael Gould (2003)
          Article 0 comments Cited 444 times – based on 0 reviews     Review now
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            Guidelines for the prevention of intravascular catheter-related infections.

            Naomi P O'Grady, Mary Alexander, Lillian Burns … (2011)
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              Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.

              Vineet Chopra, Sarah Anand, Andy Hickner … (2013)
              Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs. We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle-Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis. Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68-20·14) and those with cancer (6·67%, 4·69-8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54-4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13-71). PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing of the risk of thrombosis against the benefit provided by these devices. None. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): N. Engl. J. Med.
                Title: The New England journal of medicine
                ISSN (Electronic): 1533-4406
                ISSN (Print): 0028-4793
                Publication date (Electronic): Sep 24 2015
                Volume: 373
                Issue: 13
                Affiliations
                [1 ] From the Departments of Biostatistics and Clinical Research (J-J.P.), Infectious Diseases (J.-J.P.), Surgical Intensive Care (V.P.), Medical Intensive Care (A.S., X.V., N.T., B. Sauneuf, D.C.), and Microbiology (V.C.), Centre Hospitalier Universitaire (CHU) Caen, INSERM Unité Mixte de Recherche Scientifique 1075 COMETE (N.T.) and EA4655 Risques Microbiens (J.-J.P., V.C., D.C.), Université de Caen Normandie, Caen, Department of Medical Intensive Care, CHU Cochin (N.M., J.-P.M.), and Department of Medical and Toxicologic Intensive Care, CHU Lariboisière (B.M.), Paris, Department of Anesthesiology and Surgical Intensive Care, CHU Mondor, Créteil (N.M.), Department of Intensive Care Medicine, Centre Hospitalier Général, Chartres (P.K.), Department of Intensive Care Medicine, Centre Hospitalier Général, Versailles (A.G.), Department of Intensive Care Medicine, Centre Hospitalier Général, Corbeil-Essonnes (S.M.), Department of Intensive Care Medicine, Centre Hospitalier Général, Pontoise (S.M.), and Department of Intensive Care Medicine, Centre Hospitalier Général, Saint-Lô (M.R., B. Savary) - all in France; and the Rhode Island Hospital Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence (L.A.M.).
                Article
                DOI: 10.1056/NEJMoa1500964
                PubMed ID: 26398070
                SO-VID: 465ae5b1-ddd4-40a7-bd9d-f52201bdc788
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