Chris Jeziorkowski

Personal experience Complications overview Individual complications

385 Consecutive CVC placement over a 6 month period• 33% mechanical complication

22% failure to place 5% arterial puncture 4% catheter malposition 1% pneumothorax 1% subcutaneous hematoma <1% hemothorax <1% cardiac arrest

Arrhythmias Vascular Injury Pulmonary Complications Guide Wires

Ventricular dysrhythmias and bundle branch block • Cause by direct stimulation of endocardium• Prevented by limiting depth of guide wire

and catheter insertion to less that 16 cm

Usually recognized by pulsatile blood flow and red appearance of blood• Can use US to confirm venous placement• Can get ABG and blood gas from your

sample to compare• Can transduce the pressure and observe

wave form

Femoral artery injury can be contained with direct pressure for 15 minutes

Air on aspiration may mean you violated the pleural space

Always get confirmatory chest x ray for subclavian and IJ lines

Cases

Inattention Inexperienced operator Inadequate supervision Overtired staff

IR can remove guide wire

Thoughts?