Prospective evaluation of central venous pressure (CVP) catheters in a large city-county hospital.

Over a 12-month period, this survey was conducted prospectively to examine the complication rate associated with the insertion and use of central venous catheters on the Louisiana State University Service at Charity Hospital, New Orleans. No attempt was made to alter or influence the current techniques and methods for catheter insertion. Three-hundred and ninety-seven patients received 554 catheters. The overall complication rate was 13.7%. Major mechanical complications occurred with 4.0% of catheters, and infectious complications occurred with 5.2%. Of the 22 major mechanical complications, 13 were associated with morbidity. Twelve of the 13 complications with morbidity occurred with 286 subclavian catheterizations (4.2%), while only 1 of the 13 complications with morbidity occurred with 248 internal jugular catheterizations (0.4%). Based on these data, it is recommended that the internal jugular approach be used in the majority of patients, reserving the subclavian approach for patients on long-term parenteral nutrition or when the internal jugular approach is not feasible technically.