CVC: Informed Consent
What encompasses informed consent is discussed elsewhere. Here we present complications, some with published incidence, to inform the discussion.
CVC Complications
A meta-analysis of 26 studies encompassing 4,185 CVC procedures [1] found that ultrasound reduced the following complications in adults:
| Incidence w/ US (%) | RR vs. Landmarks | P | |
| Cannulation failure | 2 | 0.18 | < 0.001 |
| Arterial puncture | 1.8 | 0.25 | < 0.001 |
| Hematoma | 1.6 | 0.30 | < 0.001 |
| Pneumothorax | 0.1 | 0.21 | 0.014 |
| Hemothorax | 0 | 0.10 | 0.007 |
There are some complications not reduced by the addition of ultrasound. These rates are variable and not well established.
- CLABSI
- Catheter-induced thrombosis
- Arrhythmia
- Venous air embolism
Reducing CLABSI
SHEA / IDSA guidelines in 2014 made the following insertion related recommendations to reduce CLABSI [2]
Level I evidence:
- Use an alcoholic chlorhexidine antiseptic for skin preparation
- Avoid the femoral vein for central access in obese adults when the catheter is placed under planned and controlled conditions
Level II evidence:
- Have a process in place to ensure adherence to infection prevention practices, such as a checklist
- Hand hygiene prior to catheter insertion / manipulation
- Use an all-inclusive catheter cart or kit
- Use US guidance for IJ catheter insertion
- Use maximum sterile barrier precautions
- Wu SY, et al. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology. 2013 Feb;118(2):361-75.
- Marschall J, et al. SHEA/IDSA practice recommendation. Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals:2014 Update. Infect Control Hosp Epidemiol. 35 (7). 2014
