Emilia Ängeby -Institutionen för kliniska vetenskaper, Lund

Title: Methods for quality assurance and decreasing complications after central venous catheterisation.

Main supervisor: Thomas Kander M.D., PhD, Professor

Reviewers: Hans Friberg M.D. Professor & Anna Lybeck M.D., Associate Professor

Abstract

Background

Central venous catheters are essential in modern healthcare but come with risks. Mechanical complications occur within 24 hours of insertion and include bleeding, pneumothorax, nerve injury, cardiac arrhythmias and tip malposition of the CVC. Thrombosis is a complication that occurs later in the course. Studies report an incidence between 5-30% in living patients. 

Aim

The primary aim of this dissertation is to reduce the incidence of CVC-related complications.

Paper 1: To determine the incidence of CVC-tip misplacement after insertion and to identify possible independent variables associated with tip misplacement.

Paper 2: To evaluate how well a semi-automated dataset aligned with manually validated data from the CVC-MECH trial in identifying the number of CVC-related mechanical complications within 24 hours of insertion. 

Paper 3: To determine the incidence of mechanical complications after CVC insertions using a semi-automated data extraction. Secondary aim is to identify possible risk factors for mechanical complications.

Paper 4: To determine the incidence of CVC-related thrombosis and to examine if photon-counting computer tomography can detect thrombus that a detected during autopsy. 

Preliminary results

Paper 1: Any tip misplacement occurred in 3.7 (3.3–4.1%) of the catheterisations and 2.1 (1.8–2.4%) were classified as major tip misplacements. The multivariable logistic regression analyses showed that female patient gender, subclavian vein insertions, number of skin punctures and limited operator experience were associated with a higher risk of major tip misplacement, whereas increasing age and height were associated with a lower risk.

Paper 2: Minor mechanical complications occurred in 615 (4.9%) of the insertion in the semi-automated dataset and in 645 (5.1%) of the insertion in the CVC-MECH dataset. Major mechanical complications occurred in 44 (0.35%) of the insertions in data from the semi-automated dataset, compared to 48 (0.38%) of the insertion in data from CVC-MECH. Bleeding grades 3-4 were the most common major complications in both datasets. 

Significance

Knowledge about CVC-related complications and their risk factors is a prerequisite for reducing CVC-related complications, and is therefore important for decreasing patient suffering and increasing patient safety. The results from all studies will be possible to implement in clinical practice immediately after publication.

Published studies

Ängeby E, Adrian M, Bozovic G, Borgquist O, Kander T. Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations. Acta Anaesthesiol Scand. 2024;68(4):520-9.