Southwestern Surgical Congress
Image-guided placement of long-term central venous catheters reduces complications and cost

https://doi.org/10.1016/j.amjsurg.2014.08.005Get rights and content

Abstract

Background

The goals of this study were to evaluate the complication rate for intraoperative placement of a long-term central venous catheter (CVC) using intraoperative ultrasound (US) and fluoroscopy and to examine the feasibility for eliminating routine postprocedure chest X-ray.

Methods

Retrospective data pertaining to operative insertion of long-term CVC were collected and the rate of procedural complications was determined.

Results

From January 2008 to August 2013, 351 CVCs were placed via the internal jugular vein using US. Of these, 93% had a single, successful internal jugular vein insertion. The complications included 4 arterial sticks (1.14%). Starting in October 2012, postprocedure chest radiography (CXR) was eliminated in 170 cases, with no complications. A total of $29,750 in charges were deferred by CXR elimination.

Conclusions

This review supports the use of US for CVC placement with fluoroscopy in reducing the rate of procedural complications. Additionally, with fluoroscopic imaging, postprocedural CXR can be eliminated with associated healthcare savings.

Section snippets

Patients and Methods

Between January 2008 and August 2013, 351 patients underwent surgical placement of a long-term use CVC employing US and fluoroscopy. All procedures were performed by 2 surgeons at a single, university-based center. The majority of CVC placements were performed in an outpatient setting. The data extracted included patient demographics, procedure-related details, and outcome details, as indicated below.

The operative technique for placement of the CVC was similar between surgeons. The CVCs placed

Results

Between January 2008 and August 2013, a total of 351 patients underwent US-guided CVC placement with the IJV as the initial attempted site. Table 1 lists descriptive information of the study population. Patient demographics included a mean age of 56.3 ± 14.8 (range 19 to 94) years, body mass index 28.8 ± 7.9 (range 16 to 57), and sex was 58.4% female. The preoperative American Society of Anesthesiologist score for 55.8% of the patients was greater than or equal to 3. Monitored anesthesia care

Comments

The evidence for the routine use of the US for central vein access is overwhelming. In 2001, an Agency for Healthcare Research and Quality Evidence Report recommended real-time dynamic US guidance for central venous catheterization because of evidence from multiple randomized controlled trials that showed decreased number of complications with US guidance.10 In 2011, a Cochrane review of US guidance for hemodialysis catheter insertion found a significantly reduced rate of catheter placement

Conclusions

US has been confirmed to be a low cost effective measure in decreasing complication rate and increasing efficiency of CVC placement. In addition, when CVCs are placed with fluoroscopic guidance, routine postprocedure CXR can be safely eliminated at significant cost savings. The intelligent use of healthcare resources dictates combining technology resources with best practice measures to optimize patient outcomes.

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    • Cited by (0)

    The authors report no financial conflicts of interest and no external sources of financial funding.

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