Central Venous Catheter Insertion Research Articles

Sustained low catheter related infection (CRI) incidence in an observational follow-up study of 9924 catheters using automated data scripts as quality assurance for central venous catheter (CVC) management

To maintain a low incidence of Catheter Related Infections (CRI) and Catheter Related Bloodstream Infections (CRBSI), continuous follow-up studies on catheter management are necessary. The aims of the present study were to investigate the incidence of catheter tip colonisation, CRI and CRBSI in the Region, to further explore the feasibility of automatic data collection and to investigate associations between independent variables and CRI. Data from electronic patient charts on all documented central venous catheter (CVC) insertions from multiple hospitals in southern Sweden, between March 2019 and August 2020, were automatically extracted. Multivariable regression analyses were used to identify associated risk factors. In total, 9924 CVC insertions were included. The prevalence of CRI and CRBSI were 0.7% (n= 74) and 0.02% (n= 20) with incidences of 1.2/1000 catheter days and 0.3/1000 catheter days, respectively. We found a sustained low incidence of CRI and CRBSI in the Region. Catheter tips were less likely to be colonised when the subclavian route was used compared to the internal jugular route and male sex as well as increased number of catheter lumens were associated with both catheter tip colonisation and CRI. By using automated scripts, data extraction was efficient and feasible but also demonstrated that real-time quality assurance should be recommended, since this is superior to current standard.

Should Sedillot's triangle be used for central venous cannulation? A cadaveric study.

Central venous access remains an integral part of perioperative and intensive care, and several methods have been described to locate the internal jugular vein (IJV) prior to cannulation. The apex of Sedillot's triangle between the manubrial and clavicular heads of the sternocleidomastoid (SCM) muscle is a commonly used anatomical landmark for a central percutaneous approach to the IJV, but the literature highlights failures and complications when adopting this method. This cadaveric study was designed to investigate the usefulness of Sedillot's triangle to locate the IJV. Sixty-one cadavers were used for investigation at the University of Cambridge Human Anatomy Centre. Sedillot's triangle was dissected and a pin was inserted in a sagittal plane at the apex of the triangle. The location of the pin in relation to the IJV was recorded. The distance between the sternal and clavicular heads of SCM was also measured. In total, the pin inserted at the apex of Sedillot's triangle pierced the IJV in 72/117 (61.5%) of dissections, with 71.4% on the right and 52.5% on the left. There was important variation in SCM anatomy, and there was no gap between its two heads in 12% of the neck dissections. We demonstrate an overall poor success rate of the central percutaneous approach using Sedillot's triangle, although our findings are limited being a simulated cadaveric study. We support education and use of ultrasound in addition to landmark techniques to aid the safe insertion of central venous catheters.

Agranulocytosis Secondary to Cancer Chemotherapy Associated With Higher In-Hospital Mortality in Patients With Central Line Insertion During a Hospital Stay.

Background Agranulocytosis secondary to cancer chemotherapy (ASCC) remains a leading cause of morbidity and mortality. Central line-associated bloodstream infections (CLABSI) are also particularly prevalent in these populations and may portend a poorer outcome. Our study serves to investigate the relationship between patients with agranulocytosis secondary to cancer chemotherapy and the insertion of a central venous catheter (CVC) with respect to in-hospital mortality. Methods and results We utilized the National Inpatient Survey 2019 database. We utilized the International Classification of Diseases (ICD)-10 CM codes to identify ASCC and other medical comorbidities. We utilized ICD-10 PCS codes to identify CVC insertions. Multivariate logistic regression was utilized to study the effect of CVC insertion on in-hospital mortality. In patients with ASCC, CVC insertion was associated with a higher in-hospital mortality (unadjusted: 11.9% vs. 1%, p<0.001, adjusted OR 19.27, 95% CI 5.84 - 65.6, p<0.001) adjusted for baseline characteristics and other comorbidities. Patients in the study cohort who were older than 70 years of age also had a higher in-hospital mortality relative to younger age groups (adjusted OR 2.31, 95% CI 1.04-5.13, p<0.039). Conclusion In patients with ASCC, CVC insertion during hospitalization is associated withhigher in-hospital mortality.

Effects of age and comorbidities on prognosis and mortality in geriatric patient groups in ıntensive Care.

Treatment of geriatric intensive care patients is tiring and difficult for intensive care physicians due to comorbidities, accompanying acute illnesses and vulnerabilities. The aim of our study was to determine other factors affecting mortality and morbidity with age in geriatric intensive care patients. A total of 937 geriatric intensive care patients were divided into three groups as young-old (65-74 years), middle-old (75-84 years), and oldest-old (85 years and more). Demographic characteristics such as age, gender, and comorbid diseases (oncological malignancy, chronic renal failure, sepsis, chronic anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pulmonary embolism) were recorded. The number of patients who needed a mechanical ventilator, developed decubit ulcers, underwent percutaneous tracheostomy, and renal replacement therapy were recorded. In addition, the number of central venous catheter insertions for patients, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), hospitalization days, and mortality rates were recorded and compared. In the comparison between the groups in terms of gender, in the 65-74 years' age group, male gender was higher, while in the age group of 85 years and more, the female gender was found to be statistically higher. Among comorbid diseases, the rate of oncological malignancy was found to be statistically significantly lower in patients aged 85 years and more. Comparing the APACHE II scores of the patients as per the groups, scores were found to be statistically significantly higher in the oldest-old group. APACHE II Score, central venous catheter application, chronic obstructive pulmonary disease, chronic renal failure, sepsis, oncological malignancy, and renal replacement therapy were shown to be statistically significant as factors affecting death. The factors affecting the survival or hospitalization time of the patients of decubit ulcer, mechanical ventilator, percutaneous tracheostomy, chronic obstructive pulmonary disease, Sepsis, APACHE II Score, and age were shown to be statistically significant. Our study showed that not only age has an effect on mortality and morbidity in geriatric intensive care patients but also comorbidities and intensive care treatments of the patients are also effective in this process.

Early economic benefits of perioperative nasojejunal tube feeding in non-critical care adult surgical patients with gastric feed intolerance

Background: Fluoroscopy-guided endoscopic placement of nasojejunal tubes (NJT) for perioperative short- or medium-term enteral nutrition (EN) is potentially required for anatomical gastric feed intolerance. Methods: Indication for NJT and successful insertion rates was determined. NJT insertion costs were calculated and compared with central venous catheter (CVC) insertion. Duration of NJT patency in non-critical care surgical patients was determined in days in a local cohort. EN costs were calculated over a hypothetical 28-day period factoring in expected NJT replacements due to blockage and compared with parenteral nutrition (PN) via CVC, which included routine CVC changes every 10 days. Public and private sectors were compared. Results: One hundred and two (93.6%) NJTs were placed successfully, with gastric outlet obstruction the most frequent indication (40.4%) with a median 10 days’ (range 1–68 days, IQR 6–16.75 days) usage. Irrevocable blockage occurred in 33 tubes after a median 9 days (range 3–34 days; IQR 4.75–16 days). Calculated EN costs over 28 days, including NJT replacement every 9 days, reached US$1 676.12 and PN costs with CVC replacement every 10 days, US$3 461.35 (p < 0.001) in the public sector. In the private sector PN costs at 28 days were significantly higher (p < 0.001) at US$5 261.14 compared with EN US$3 780.71. The cost benefit of EN over PN is seen after three days in the public, and four days in the private sector. Conclusion: Exponential cost saving occurs with EN via NJT over time, even when factoring in the likelihood of NJT replacements.

Simulation-based Mastery Learning Improves Critical Care Skills of Advanced Practice Providers.

Advanced practice providers (APPs) are essential members of intensive care unit (ICU) interprofessional teams and are expected to be competent in performing procedures. There are no published criteria for establishing when APPs can independently perform procedures. Simulation-based mastery learning (SBML) is an effective strategy for improving critical care skills but has not been applied to practicing ICU APPs. The purpose of this study was to evaluate if an SBML curriculum could improve the critical care skills and procedural self-confidence of ICU APPs. We performed a pretest-posttest study of central venous catheter (CVC) insertion, thoracentesis, and mechanical ventilation (MV) management skills among ICU APPs who participated in an SBML course at an academic hospital. For each skill, APPs underwent baseline skills assessments (pretests) on a simulator using previously published checklists, followed by didactic sessions and deliberate practice with individualized feedback. Within 2 weeks, participants were required to meet or exceed previously established minimum passing standards (MPS) on simulated skills assessments (posttests) using the same checklists. Further deliberate practice was provided for those unable to meet the MPS until they retested and met this standard. We compared pretest to posttest skills checklist scores and procedural confidence. All 12 eligible ICU APPs participated in internal jugular CVC, subclavian CVC, and MV training. Five APPs participated in thoracentesis training. At baseline, no APPs met the MPS on all skills. At training completion, all APPs achieved the mastery standard. Internal jugular CVC pretest performance improved from a mean of 67.2% (standard deviation [SD], 28.8%) items correct to 97.1% (SD, 3.8%) at posttest (P = 0.005). Subclavian CVC pretest performance improved from 29.2% (SD, 32.7%) items correct to 93.1% (SD 3.9%) at posttest (P < 0.001). Thoracentesis pretest skill improved from 63.9% (SD, 30.6%) items correct to 99.2% (SD, 1.7%) at posttest (P = 0.054). Pretest MV skills improved from 54.8% (SD, 19.7%) items correct to 92.3% (SD, 5.0%) at posttest (P < 0.001). APP procedural confidence improved for each skill from pre to posttest. SBML is effective for training APPs to perform ICU skills. Relying on traditional educational methods does not reliably ensure that APPs are adequately prepared to perform skills such as CVC insertion, thoracentesis, and MV management.

Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials

BackgroundThe anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications.MethodsWe retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization. The primary outcome was the required catheter dwell time, defined as the period between the first catheter insertion and removal of the last catheter for absence of utility. Predictors were identified in the training cohort (3SITES trial; 2336 patients) through multivariable analyses based on the subdistribution hazard function accounting for death as a competing event. Internal validation was performed in the training cohort by 500 bootstraps to derive the CVC-IN score from robust risk factors. External validation of the CVC-IN score were performed in the testing cohort (CLEAN, and DRESSING2; 2371 patients).ResultsThe analysis was restricted to patients requiring mechanical ventilation to comply with model assumptions. Immunosuppression (2 points), high creatinine > 100 micromol/L (2 points), use of vasopressor (1 point), obesity (1 point) and older age (40–59, 1 point; ≥ 60, 2 points) were independently associated with the required catheter dwell time. At day 28, area under the ROC curve for the CVC-IN score was 0.69, 95% confidence interval (CI) [0.66–0.72] in the training cohort and 0.64, 95% CI [0.61–0.66] in the testing cohort. Patients with a CVC-IN score ≥ 4 in the overall cohort had a median required catheter dwell time of 24 days (versus 11 days for CVC-IN score < 4 points). The positive predictive value of a CVC-IN score ≥ 4 was 76.9% for > 7 days required catheter dwell time in the testing cohort.ConclusionThe CVC-IN score, which can be used for the first catheter, had a modest ability to discriminate required catheter dwell time. Nevertheless, preference of the subclavian site may contribute to limit the risk of intravascular complications, in particular among ventilated patients with high CVC-IN score.Trials Registration NCT01479153, NCT01629550, NCT01189682

Rare case of calcified fibrin sheath causing central venous occlusion, mimicking a retained catheter fragment

BackgroundLong-term placements of central venous catheters (CVCs) are known to cause various complications, among which include fibrin sheath formation, causing catheter dysfunction, infection and thrombosis. Post-catheter removal, these sheaths may sometimes be retained in the vein; however, are rarely calcified. When retained sheaths are calcified, they may cause diagnostic confusion on imaging, as they may mimic a retained catheter fragment.Case presentationWe report a case of a patient with end-stage renal disease and a history of multiple prior CVC insertions presenting with symptoms of central venous occlusion post-revascularization of his stenosed arteriovenous fistula. CT venography revealed a linear tubular hyperdensity within the right brachiocephalic vein and superior vena cava, which at first glance looked like a retained catheter fragment. However, further scrutiny revealed a retained calcified intravascular fibrin sheath as the cause of occlusion.ConclusionsAwareness of the radiological discriminating features of calcified fibrin sheaths are important to prevent misdiagnosis and unnecessary interventions as these sheaths may mimic retained catheter fragments. Calcified fibrin sheaths should also be considered as a differential diagnosis of radio-opaque intravascular structures or venous calcifications post-CVC removal.

Percutaneous Suture - Closure Device Used for Iatrogenic Carotid Artery Injury Management: Case Report and Review of Literature.

Accidental carotid artery injury is an uncommon but serious central venous catheter insertion complication. Hemostasis might not be readily achieved by manual compression; therefore, surgery or endovascular treatment remains the mainstay for accidental carotid artery injury. However, not all patients are suitable candidates for surgery.Vascular closure devices are widely used in femoral arteries to achieve hemostasis and early ambulation. The use of vascular closure devices is occasionally reported in other vascular beds. Here we present a case of an iatrogenic left common carotid artery injury treated by vascular closure device, which is of help in the future management of this complication.

Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement.

Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear. We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications. We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed. A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications. Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.

Management of arterial trauma during central venous catheter insertion using a percutaneous suture-mediated closure device (Perclose ProGlide): a report of two cases and literature review

We evaluated the safest approach to treat catheter-related cervicothoracic arterial injuries by reviewing two inadvertent arterial injury cases during central venous catheter insertion and their related complications at an intensive care unit. In the first case, C-arm angiography confirmed accidental catheter placement in the right subclavian artery (SCA). In the second case, accidental catheter placement in the right common carotid artery was confirmed via computed tomography angiography of the neck and chest. The catheter was connected to a high-pressure arterial bag in both cases. The Perclose ProGlide Suture-Mediated Closure System (Abbott Laboratories, IL, USA) was used and successfully operated the two cases of iatrogenic SCA and carotid artery injuries. A follow-up bedside ultrasound at 2 and 6 hours postoperatively revealed normal Doppler waveforms in the inadvertent arterial injury and distal arteries without hematoma at the puncture site in both cases. In conclusion, for inadvertent artery puncture, which occurs in &lt;12% of jugular and subclavian venous procedures, the endovascular approach using a covered stent appears to be safe for treating the accidental catheter placement in the carotid artery, although some cases of post-procedure stroke have been reported. In this regard, the percutaneous arterial suture device (Perclose ProGlide) offers an almost 100% success rate and lowers morbidity and mortality rates compared with open surgical and endovascular approaches for treating iatrogenic SCA and carotid artery injuries. These two cases highlight the effectiveness of minimally invasive percutaneous arterial closure devices in treating this infrequent but potentially lethal injury.

Evaluation of the incidence of central venous catheter-associated infections in patients admitted in the intensive care unit of a tertiary hospital in Nigeria

Background: Presence of a central venous catheter (CVC) though useful may lead to CVC-associated bloodstream infections (CVCBSIs), resulting in increased morbidity and mortality. Objectives: The objectives of the study were to determine the incidence of CVCBSIs, the predominant causative microorganisms, the antibiotic sensitivity pattern of the microorganisms, and the associated risk factors. Materials and Methods: This prospective observational study evaluated the incidence of CVCBSIs in patients who had the catheter inserted on admission into the intensive care unit (ICU) of a tertiary hospital in South-East, Nigeria. Sixty-eight patients were recruited for the study. Blood samples were collected aseptically from a peripheral vein on admission, 72 h after the insertion of CVC, and at removal of CVC for blood culture. The distal 5 cm of the CVC was also collected at removal for microscopy, culture, and sensitivity testing. Results: Six out of all the patients recruited developed CVCBSIs, giving an incidence rate of 9.2%, whereas 48% (n = 31) developed catheter bacterial colonization. Over one-fifth (22.7%) of the patients with catheter duration beyond 5 days had CVCBSIs. Patients whose CVC duration was beyond 5 days had a higher risk of CVCBSIs (P = 0.015) than others. The commonest microorganism isolated was Staphylococcus aureus, whereas the most susceptible antibiotic was aminoglycoside (gentamycin). Conclusion: The incidences of CVCBSIs and CVC colonization were 9.2% and 48%, respectively. The duration of catheterization was found to be a major risk factor for CVCBSIs. The most predominant organism isolated was S. aureus. The most sensitive antibiotic agent was the aminoglycoside (gentamycin). It is therefore recommended that catheter care bundle which includes hand hygiene, use of chlorhexidine for skin preparation during insertion, use of barrier precautions during insertion, and the removal of unnecessary central lines should be strictly adhered to. Gentamycin should be used as empirical antibiotics in the ICUs.

Hemothorax after central venous catheter insertion in patient with triple antithrombotic therapy: A case report

Hemothorax after central venous catheter insertion in patient with triple antithrombotic therapy: A case report

Malpositioning of Long-Staying Central Venous Catheters in the Pediatric Population: Incidence and Potential Complications. A Single-Center Retrospective Study and a Narrative Review of the Literature.

Central Venous Catheters insertion is a very common procedure performed at the operation room and the Intensive Care Unit. In the paediatric population they are frequently used to administer fluids, blood products, resuscitation drugs, parenteral nutrition and chemotherapy. One of the reported complications, though a less commonly described one, is the inappropriate position of the tip of the CVC in a vessel other than the superior vena cava. In this study, we initially present the anatomy of the superior vena cava system and that of the internal jugular vein, the optimal catheter tip position as well as the possible suboptimal catheter tip locations. Subsequently, paediatric chest X-rays of our hospital with catheter tip malpositioning are illustrated, after internal jugular vein catheterization. Following, we discuss possible mechanisms of central venous catheters malpositioning, signs and symptoms which could help us identify a wrong placement and also how to prevent as well as how to fix one. Finally, an interrelation between malpositioning, malfunction and the existence of infection or thrombosis is investigated. Our study concluded that the right internal jugular vein should be the first choice in all cases of vessel implantation, mainly based on our statistical analysis results, which suggested that this vessel was associated with the least possibility of erroneous catheter placement. Another important clue of our study is based on the fact that the inappropriate positioning of a central venous catheter over the long term could be a significant predisposing factor of malfunction, along with infection and thrombosis.

Retracted: Time to First Dressing Change after Peripherally Inserted Central Venous Catheter (PICC) Insertion in Breast Cancer Patients.

[This retracts the article DOI: 10.1155/2022/9380796.].

Incidence of central line-associated bloodstream infection in the intensive care unit: A prospective observational study

Aims: The aim of this study was to determine the incidence of central line-associated bloodstream infections (CLABSIs) in the medical and surgical intensive care units (ICUs) of a tertiary care hospital. Materials and Methods: One hundred and twenty patients admitted to medical and surgical ICU with an indwelling, nontunneled central venous catheter (CVC) inserted at admission in the department of emergency medicine or at medical and surgical ICU for more than 48 h were monitored. The patients were followed up daily for the development of new-onset sepsis after 48 h of insertion of CVC, by analyzing the culture of two sets of blood samples, over a span of 24 h. The data were evaluated statistically using Microsoft Excel version 11 and SPSS version 17 (IBM, USA). Results: Among 120 patients hospitalized for an aggregate of 972 days, 7 patients had acquired CLABSI with an incidence rate of 7.2/1000 central line days. The organisms isolated were Staphylococcus aureus, Acinetobacter spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae. Conclusion: The incidence rate of CLABSI in this study was in line with other studies on the CLABSI rate in India. The study found a significant association of CLABSI with duration of CVC catheterization, underlying comorbid conditions and diseases of patients, and indication of CVC insertion. However, there was no significant association of CLABSI with age of patients, their gender, and site of insertion.

Clinical epidemiology and a novel predicting nomogram of central line associated bloodstream infection in burn patients.

Burn patients are at high risk of central line-associated bloodstream infection (CLABSI). However, the diagnosis of such infections is complex, resource-intensive, and often delayed. This study aimed to investigate the epidemiology of CLABSI and develop a prediction model for the infection in burn patients. The study analysed the infection profiles, clinical epidemiology, and central venous catheter (CVC) management of patients in a large burn centre in China from January 2018 to December 2021. In total, 222 burn patients with a cumulative 630 CVCs and 5,431 line-days were included. The CLABSI rate was 23.02 CVCs per 1000 line-days. The three most common bacterial species were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa; 76.09% of isolates were multidrug resistant. Compared with a non-CLABSI cohort, CLABSI patients were significantly older, with more severe burns, more CVC insertion times, and longer total line-days, as well as higher mortality. Regression analysis found longer line-days, more catheterisation times, and higher burn wounds index to be independent risk factors for CLABSI. A novel nomogram based on three risk factors was constructed with an area under the receiver operating characteristic curve (AUROC) value of 0.84 (95% CI: 0.782-0.898) with a mean absolute error of calibration curve of 0.023. The nomogram showed excellent predictive ability and clinical applicability, and provided a simple, practical, and quantitative strategy to predict CLABSI in burn patients.

Determination of Central Venous Catheter Complications: Internal Jugular Vein versus Femoral Vein Catheterization

Aim: This research aimed to compare the mechanical, thrombotic, and infectious complication ratio of the internal jugular vein with those of femoral vein catheterization. Materials and Methods: It is a single-center retrospective study. One hundred seventy-nine pediatric patients undergoing central venous catheter insertion in the intensive care unit were selected from February 2020 to August 2021. The patients were divided into 2 groups based on catheter type; internal jugular versus femoral venous catheterization. Procedure complications rates were assessed. However, jugular catheterization was performed under ultrasound guidance, and femoral venous catheterization was inserted via an original landmark-based technique. Thromboprophylaxis was performed on all patients without coagulopathy. Results: The overall rate of procedural complications was 20%. The subcutaneous hematoma was the most common mechanical complication and higher in femoral attempts (p= 0.001), followed by arterial injury (p= 0.002). Thrombotic complications were similar between the two groups (p= 0.053). Infections complications were higher in femoral venous catheterization (p= 0.016). Conclusion: Femoral venous catheterization is associated with a greater risk of mechanical and infectious complications than internal jugular venous catheterization. Usage of ultrasound during catheterization procedures decreases mechanical complications.

Comparison of Complications in Patients with Central Venous Catheter Placement Via Internal Jugular, Subclavian and Femoral Route at Intensive Care Unit

Central venous lines are passed in almost all patients admitted in intensive care unit and a need still exist to look for best route for this purpose. Objective: To compare the complications in patients with central venous catheter passed via internal jugular, subclavian and femoral route at intensive care unit. Methods: A comparative cross-sectional study was conducted on 380 patients admitted in intensive care unit of Bahria International Hospital RWP from January 2022 to June 2022. Central venous catheters were passed by consultant critical care specialist on call at the time of reception of patient in unit. All the patients were observed for one week for presence of any local or systemic complications. Results: Out of 380 patients, 240 (63.2%) were male while 140 (36.8%) were female. Central venous catheter was passed via internal jugular vein in 220 (57.8%) patients, via subclavian route in 60 (15.8%) patients and via femoral route in 100 (26.3%) patients. Failed attempts were seen statistically significantly more in internal jugular route (p-value-0.041) while local cellulitis was seen more in femoral route (p-value-0.012). Conclusions: Internal Jugular vein was the route most commonly used for insertion of central venous catheter in patients admitted in our intensive care unit. Complications were seen more not very common in our setting. Failed attempts were more seen in internal jugular route while local cellulitis was seen more in femoral route.

Routine postoperative admission to the neurocritical intensive care unit after microvascular decompression: necessary or can it be abandoned?

Postoperative neurocritical intensive care unit (NICU) admission of patients who underwent craniotomy for close observation is common practice. In this study, we performed a comparative analysis to determine if there is a real need for NICU admission after microvascular decompression (MVD) for cranial nerve disorders or whether it may be abandoned. The present study evaluates a consecutive series of 236 MVD surgeries performed for treatment of trigeminal neuralgia (213), hemifacial spasm (17), vagoglossopharyngeal neuralgia (2), paroxysmal vertigo (2), and pulsatile tinnitus (2). All patients were operated by the senior surgeon according to a standard protocol over a period of 12years. Patients were admitted routinely to NICU during the first phase of the study (phase I), while in the second phase (phase II), only patients with specific indications would go to NICU. While 105 patients (44%) were admitted to NICU postoperatively (phase I), 131 patients (56%) returned to the ward after a short stay in a postanaesthesia care unit (PACU) (phase II). Specific indications for NICU admission in phase I were pneumothorax secondary to central venous catheter insertion (4 patients), AV block during surgery, low blood oxygen levels after extubation, and postoperative dysphagia and dysphonia (1 patient, respectively). There were no significant differences in the distribution of ASA scores or the presence of cardiac and pulmonary comorbidities like congestive heart failure, arterial hypertension, or chronic obstructive pulmonary disease between groups. There were no secondary referrals from PACU to NICU. Our study shows that routine admission of patients after eventless MVD to NICU does not provide additional value. NICU admission can be restricted to patients with specific indications. When MVD surgery is performed in experienced hands according to a standard anaesthesia protocol, clinical observation on a neurosurgical ward is sufficient to monitor the postoperative course. Such a policy results in substantial savings of costs and human resources.