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Risk Factors for Central Venous Catheter-Related Vascular Erosions

Johns Hopkins Medical Institutions, Department of Surgery, Baltimore, Maryland

Mark A. Talamini, M.D.

Johns Hopkins Medical Institutions, Department of Surgery, Baltimore, Maryland

James V. Sitzmann, M.D.

Johns Hopkins Medical Institutions, Department of Surgery, Baltimore, Maryland

Risk factors for superior vena cava perforations following central venous catheterization for total parenteral nutrition were identified in a retrospective study of 1058 catheters in 853 patients; 540 of these catheters were size 16-gauge (51%) and 518 size 14-gauge (49%). Of the size 14-gauge catheters, 274 (53%) were right-sided and 244 (47%) were left-sided subclavian catheters. Four patients (0.4%) had superior vena cava perforation. All had left-sided large bore 14-gauge catheters. All patients experienced acute symptoms and all had pleural effusions. There was no mortality directly related to vascular erosions. Two risk factors were identified for this complication: (1) catheters originating from the left side (p < 0.05), or (2) large catheters (size 14-gauge or larger) (p < 0.01). We conclude that large bore or left-sided central venous catheter placement represents an increased risk of superior vena cava perforation. (Journal of Parenteral and Enteral Nutrition 15:513-516, 1991)

Journal of Parenteral and Enteral Nutrition, Vol. 15, No. 5, 513-516 (1991)
DOI: 10.1177/0148607191015005513


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