RESUMO
PURPOSE: Central venous catheterization is a standard procedure in intensive care therapy. In developing countries, this intervention is frequently performed by physicians in training and without the availability of ultrasound guidance. Purpose of this study was to determine the incidence and potential risk factors for mechanical complications during central venous catheterization in an intensive care setting performed by a mixed group of practitioners without the use of adjunct ultrasound. METHODS: Prospective observational cohort study in a university teaching hospital. Three hundred critically ill patients requiring their first central venous catheter insertion were enrolled. All patients were observed for 24 hours for mechanical complications (pneumothorax, hemothorax, arterial puncture, incorrect tip position, cardiac dysrhythmia, and/or subcutaneous hematoma). Potential associations with mechanical complications were adjusted using multivariable analysis. Main outcome was the cumulative incidence of mechanical complications. RESULTS: The incidence of mechanical complications was 17% (n = 51). After covariate adjustment, the number of punctures was significantly related to mechanical complications. Compared with 1 puncture, 3 or more attempts were significantly associated with mechanical complications (odds ratio 3.62 [95% confidence interval 1.34-9.8]; P = .011). Experience of the operator was not associated with mechanical complications. CONCLUSIONS: The incidence of mechanical complications is affected by the number of punctures performed. After adjustment, the risk increases substantially with more than 3 attempts. Limiting the number of attempts, appropriate supervision and the use of ultrasound guidance when available are recommended for the further reduction in mechanical complications of central venous catheterization.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cuidados Críticos , Estado Terminal/terapia , Feminino , Humanos , Incidência , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/lesões , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Punções , Ultrassonografia de IntervençãoRESUMO
Antecedentes: El desarrollo de técnicas para la realización de una traqueostomía percutánea por dilatación (TPD) ha facilitado su implementación en las unidades de cuidados intensivos (UCI). Objetivo: Describir las complicaciones tempranas intra y postoperatorias en pacientes de cuidados intensivos que requirieron traqueostomía percutánea por dilatación utilizando la técnica Ciaglia Blue Rhino y que se realizaron sin la asistencia de fibrobroncoscopio. Pacientes y métodos: Se revisaron de forma retrospectiva los registros cínicos de 80 pacientes durante un periodo de 3 años. Se registraron las variables demográficas, de severidad, días de ventilación mecánica antes del procedimiento y las complicaciones intraoperatorias y postoperatorias tempranas. Resultados: Se incluyeron 80 pacientes con una edad media de 61,5 (15-89) años (29 mujeres). La media de puntuación APACHE II fue 17,9. Los pacientes requirieron en promedio 11,6 días de ventilación mecánica antes de la TPD. El 11,6% presentó complicaciones intraoperatorias y el 9,1% complicaciones postoperatorias tempranas. En 2 pacientes se puncionó accidentalmente el tubo endotraqueal y 3 pacientes presentaron sangrado autolimitado del sitio de traqueostomía. Ninguna de las complicaciones representó un riesgo vital para los pacientes. Conclusiones: La TPD mediante la técnica Ciaglia Blue Rhino sin la asistencia de fibrobroncoscopio es un procedimiento con baja incidencia de complicaciones.
Background: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU).Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy using the Ciaglia Blue Rhino technique, without fiber optic bronchoscopy.Patients and methods: We collected data from eighty ICU patients during three years. The demographic variables were recorded, in addition to severity, number of days in mechanical ventilation prior to the procedure and intraoperative as well as early postoperative complications.Results: Eighty patients included, mean age 61.5 (15-89) years old (29 females). The mean APACHE II score was 17.9. In average, the patients required 11.6 days of mechanical ventilation prior to the PDT. 11.6% had intraoperative complications and 9.1% experienced early postoperative complications. In two patients the endotracheal tube was accidentally punctured and three patients had self-limiting bleeding at the tracheostomy site. None of the complications was life-threatening to the patients.Conclusions: PDT using the Ciaglia Blue Rhino technique, without fiber optic bronchoscope is a procedure with low incidence of complications.