Chest
Clinical Investigations in Critical CareVascular Erosion by Central Venous Catheters: Clinical Features and Outcome
Section snippets
Methods
St. Joseph's Hospital and Medical Center (Phoenix) is a 626-bed teaching hospital that has 61 adult critical care beds. During an 18-month period spanning 1990 to 1991, patients with vascular erosion by central venous catheters were identified by evaluating medical records coded with pleural effusion as a hospital discharge diagnosis and canvassing attending physicians. Patients were included into the study if a pleural effusion first appeared or progressed after placement of a central venous
Results
Eight patients with central catheter erosion resulting in hydrothorax were found by review of medical records. Catheter insertion in these patients represented 0.5 percent of all central lines delivered to adult patient care areas during the study period. The patients’ epidemiologic data, route of catheterization, and fluid infusions are listed in Table 1. All catheters were made of polyurethane and placed with a Seldinger technique. Four patients had double-lumen catheters, one patient had a
Discussion
Despite the advent of pliable central venous catheters with tapered tips, the eight patients with hydrothoraces in this study and the persistently recurrent nature of case reports during the last two decades indicate that catheter erosion remains an important clinical problem. The incidence of this complication appears to be approximately 0.4 percent to 1.0 percent of catheter placements as observed in our experience and that of others.29 The true incidence may be considerably higher, however,
ACKNOWLEDGMENTS
The authors thank Cynthia Rockow for excellent secretarial assistance and Kay Wellik for library services.
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Manuscript received September 23; revision accepted December 16.