Access time and complications in central venous catheter insertion in patients presenting to the emergency department of a tertiary hospital: A prospective cohort

Abstract

Objective: This study compares the access time and procedural-related complications in CVC insertion via ultrasound guidance versus the landmark technique. Methods: A prospective cohort study was performed in the emergency department of a tertiary care hospital from January 2016 to December 2018. Patients with the indication of CVC insertion were included. Primary outcomes included access time and total procedure time; secondary outcomes included post-procedural complications. Seldinger’s Technique was adopted for CVC insertion in both groups. For qualitative variables, chi-squared and Fisher’s exact tests were applied, and quantitative variables were reported as mean and standard deviation. Differences were assessed by the independent t-test and the Mann-Whitney test. Results: A total of 252 patients were enrolled and divided into exposed (ultrasound-guided technique) and unexposed (landmark guided technique) groups. Insertion of CVC on the first attempt was successful in 82 patients (62.1%) in the ultrasound group and in 68 patients (56.7%) in the landmark group. The mean access time (seconds) in the exposed group was 21.9 and in the unexposed group was 29.9 with a mean difference of only 8 seconds. The total procedural time (in minutes) was 32.2 versus 22.7 sequentially with a mean difference of 9.5 minutes. Fewer venipuncture attempts and arterial pricks were recorded in the exposed group (1.4 and 10/132) as compared to the unexposed group (1.8 and 36/120). Conclusion: Ultrasonographical-inserted CVC had a higher success rate with fewer post-procedural complications but required longer total procedural time with inappreciable access time.

Keywords:

• central venous catheter
• ultrasound
• landmark technique
• emergency
• internal jugular vein

Acknowledgments

Data collectors & Health Information and Management Systems (HIMS) Aga Khan University Pakistan.

Disclosure statement

No potential conflict of interest was reported by the authors.

Abbreviations

CVC – Venous Catheter

ED – Emergency Department

LCT – Landmark Guided CVC insertion Technique

UCT – Ultrasound Guided CVC insertion Technique

Authors’ contributions

FA& ES- Conceptualization, supervision, writing, reviewing & editing.

SS & AF- Data curation, formal analysis, writing, reviewing & editing.

UA & ZD- Methodology, writing, reviewing & editing.

Additional information

Funding

Not applicable

Notes on contributors

Fareed Ahmed

Fareed Ahmed is a Senior Instructor, Department of Emergency Medicine, Aga Khan University, Karachi Pakistan.

Umaira Aftab

Umaira Aftab is a Medical Officer, Department of Emergency Medicine, Aga Khan University, Karachi Pakistan.

Salman Muhammad Soomar

Salman Muhammad Soomar is a Instructor (Research), Department of Emergency Medicine, Aga Khan University, Karachi Pakistan.

Asher Feroz

Asher Feroz is aResearch Specialist, Department of Emergency Medicine, Aga Khan University, Karachi Pakistan.

Zeyanna Dhalla

Zeyanna Dhalla is a Research Intern, Department of Emergency Medicine, Aga Khan University, Karachi Pakistan and Student MSc Health Policy and Managment at University of Michigan, Ann Arbor, USA.

Emaduddin Siddiqui

Emaduddin Siddiqui is a Associate Professor, Department of Emergency Medicine, Aga Khan University, Karachi Pakistan.