The present study showed that the highest type of central vein catheterization in Imam Reza medical research and training hospital were done thorough the jugular vein in between the right jugular vein appropriating 88.1% of patients. Most of them were done in patients who went through a shock by 2nd-year residents in day shifts.
In one study that proceeded to the evaluation of central venous catheter complications through each anatomical location, it was reported that the highest preference for central vein catheterization in the emergency department was a femoral vein (
Regarding some of the complications of catheterization, part of the researchers represent that infection of the site of catheter insertion can be prevented by Subcutaneous Tunneling (
The present study showed that the overall and cumulative complication of the process was almost 4.5% and hematoma of the catheter insertion location was the prevalent complication (3%). This is while other researchers reported this value between 0.3% - 12%. This rate shows that complications that occurred in this study is significantly lower than the average rate and it is obvious that there are lower risks of complication occurrence than other researchers (
Indeed, the significant point in this case is that in the researchers mentioned above, the process of catheterization had been done by the attending physicians, however, in this study, most cases of central vein catheterizations had been done by residents (
Like the findings of some researchers that have been done in this field, it shows that the prevalence of infections due to catheterization is one of the important complications of this procedure and therefore, the exact evaluation of this complication seems necessary (
According to that, patients who were studied in this research only entered this study from the emergency department and therefore, computation of the rate of the catheter infection or infection of the catheter location in long-lasting time isn’t possible and just acute complications were evaluated in this research.
Results and finding of the present study showed that incidence of complications in central vein catheterization thorough subclavian veins is significantly high and the prevalence of complication reaches to 33%. Furthermore, in the central vein catheterization through subclavian vein, hematoma of the location of catheter insertion is the most common complication (25%).
The central vein catheterization through the subclavian vein has complications itself and can't be denied or disregarded, however, it should be noted that presumably due to the low number of cases of catheter insertion from this anatomical location, the basis of experience and ingenuity of residents isn’t adequate.
In the viewpoint of timing (physician-centered) of the catheterization, among all studied patients, 73 of them was in the 1st half of their work shift (54.47%) as well as 61 of them in the second half of their work shift and furthermore, 77 patients in the day shift (57.46%) and 57 patients in the night shift (42.53%) underwent catheterization.
Physicians who inserted the patients’ catheterizations, in 19 cases, were 1st year residents (14.2%), in 101 cases were 2nd year residents (75.4%), in 11 cases were 3rd year residents (8.2%), and in 3 cases were attending physicians (2.2%). In the Barberra et al. study, it was reported that inserting the catheterization by a proficient physician significantly had reduced the complications of the procedure and on the other hand, emphasized to continuous training and active catheterization to the physicians (
In the viewpoint of time-related factors, among all studied patients, 73 of them underwent central vein catheterization in the first half of the work shift (54.47%), which includes 1 case of pneumothorax and 2 cases of hematoma. Furthermore, catheterization had been done for 61 patients in the second half of the work shift (45.53%) had 2 cases of hematoma and 1 case of difficult catheterization in point of complications.
Through all catheterizations, 77 patients underwent the procedure during the day shift (57.46%) thad 1 case of pneumothorax and 1 case of hematoma in point of complications. In addition, 57 patients who underwent the procedure during the night shift (42.53%) had 1 case of difficult catheterization and 3 cases of hematoma.
Physicians who inserted the patients’ catheterizations, in 19 cases, were 1st year residents (14.2%), in 101 cases were 2nd year residents (75.4%), in 11 cases were 3rd year residents (8.2%) and in 3 cases were attending physicians (2.2%). In point of complications in each group: there were 2 cases of hematoma in the 1st year residents group (1.5%), and 1 case of difficult catheterization, 1 case of pneumothorax as well as 1 case of hematoma in 2nd year residents group (2.25%), and also 1 case of hematoma in 3rd year residents (0.7%).
In the study done by Puri et al., central vessels, catheterization complications were evaluated in critically ill patients prospectively. In that research, there were 210 enterprises of catheterizations on 116 patients. In 80 patients, central vein catheterizations had been done, 71 patients with pulmonary artery, and in 59 patients arterial catheterization. In all cases, except 7, percutaneous catheterization had been done. Patients who had central vein catheterization in 3.7% of cases, pulmonary artery catheterization in 10% of cases, and other patients in 13.5% of cases catheterization complications had been reported. Authors conclude that catheterization with significant complications correlates with patients’ recovery process (
Patient-related factors that contribute in catheterization such as short neck and obesity was seen in 58 patients, which was1 case of difficult hematoma, 1 case of pneumothorax, and 1 case of hematoma had been reported (2.25%). Among other patient-related factors, incorporation of a patient with a physician who inserts the catheter and continuous movements that reported in 23 patients among whom 2 cases of hematoma have been reported (1.5%). Other patient-related factors are which were related to neck motility. There was impaired neck motility in 8 patients and 1 case of hematoma was reported (0.07%).
Another study done by Fergosene et al. proceeded to the evaluation of patient-physician cooperation factors, domination degree of a physician who inserts the catheter, and patient factors. In that research, they studied 118 patients who underwent a central vein catheterization. Through that, authors concluded that complications of catheterization had a significant correlation with patient cooperation (P = 0.00), tiredness of the individual who inserted the catheterization (P = 0.02), the existence of patients unfavorable physical condition such as obesity (P = 0.04) (
13). 4.1. Conclusion
According to findings of the present study and discussion regarding the patient’s catheterization: the majority of patients who almost underwent a catheterization through the right jugular vein, which is undoubtedly an easy access to that vein, ability to do ultrasonography in case of catheterization failure and training are effective factors. Near one-third of patients underwent an ultrasonography for implementation of the catheter insertion.
Among complications of catheterization, in both jugular and subclavian veins, hematoma of the location of the catheter is the most reported complication. With do attention to the timing of the gathered data, the majority of physicians who do the patient’s catheterization were 2nd residents, which had the most reported complications. This is while the catheterizations done by the attending physicians were uncomplicated. In regards to the descriptive nature of this study, the central vein catheterizations complications in which group is higher aren’t able to be defined. Overall reported complications rate in this study (4.5%) is lower than the results reported in other accomplished studies (0.3% - 12%), which indicates effective training on this field in the emergency department.
4.2. Limitation and Recommendation
More researchers should be done in other hospitals of the country for use of direction of integration and concordance of catheterization-related planning and preparation of related guidelines. Through this study, the acute complications of central vein catheterization were evaluated. It is recommended to do extended studies in regarding long-term complications of each of central veins catheterization.