A prospective clinico-bacteriological study of internal jugular cannulation in a critical care unit.

ABSTRACT

The results of 125 consecutive central venous catheterizations during a six-month period in the critical care unit were prospectively studied. All the catheters were inserted percutaneously by internal jugular approach and the placement of catheters was confirmed by chest roentgenography while injecting Conray 420. The safety of the technique was evaluated in terms of success and complication rates. Failure rate was only 0.8 per cent, while overall complication rate was 17.6 per cent. Arterial puncture and hematoma were the commonest complications encountered in 8 and 4 per cent of the patients respectively. Pneumothorax occurred in two patients (1.6%), while misplacement of catheter tip and thrombophlebitis was encountered in 0.8 per cent of all cannulations. No microorganisms were isolated from catheters inserted for less than 5 days. Positive catheter-tip cultures, by quantitative method, were obtained in 41 cases (P < 0.001) of which infected intravenous insert growing > 10(3) colony forming units, was encountered in 36 (P < 0.001) and colonization of the catheter (< 10(3) colony forming units) was seen in 5 cases. Catheter related bacteremia (recovery of the same organism from the catheter tip and peripheral blood cultures) occurred in 31 of these 41 patients (P < 0.01). The study reveals that internal jugular approach is a safe technique for central vein catheterization with very high success rate and fewer complications. However, catheter-related bacteremia is a potential threat which is directly related to the number of days the catheter is in central circulation and is totally preventable.