Immediate complications of cvc insertions: Feasibility pilot of a UK national audit (icnap)

Learning Objectives: The placement of central venous catheters (CVCs) is common in modern critical care practice. Whilst infectious complications have been reduced in the last decade, mechanical complications of central venous cannulation remain a significant cause of morbidity and mortality. In the UK this burden has not been quantified before. This feasibility pilot of the Intensive Care National Audit Project assessed the data collection tool and the immediate complication rates in five different hospital settings. Methods: Using a recently developed electronic data collection system, all CVCs inserted to patients admitted to the ICU in 5 hospitals (2 university hospitals and 3 major teaching hospitals) were documented over a two-week period. Indication, insertion site, experience of the operator, use of ultrasound (U/S), use of CXR, number of skin punctures and immediate complications were recorded in an anonymised database. Results: 117 data collection forms were submitted. Users found the electronic data collection system easy to use. All data fields were ready for analysis immediately after inputting the data. Out of the 117 CVCs, 17 were haemodialysis lines and 5 PA sheets. 85% of the CVCs were inserted by experienced practitioners (at least 3 years experience). 95 (80%) of the CVCs were inserted in the internal jugular, 14 in the femoral and 9 in the subclavian veins, respectively. U/S was used for 109 (93%) of CVC insertions and its use was not associated with fewer complications. In 15 cases venopuncture was attempted more than once (all with U/S) and this was associated with significantly increased risk of complications. There were 12 immediate complications (10.5%), 5 related to inability to pass a guidewire, 2 carotid punctures, 3 inadequate positioning of the tip of the CVC and 1 significant arrhythmia. Conclusions: Our feasibility pilot showed that our proposed data collection tool is appropriate for the planned national survey. The 10% complication rate in the hands of experienced practitioners is alarming. Potential long-term morbidity from these will be determined during the national study