Efficacy of a central venous access service.

A central venous access service (CVAS) was created in a 600-bed teaching hospital to do elective percutaneous central venous catheterization (PCVC) in a safe and expeditious manner. A vascular surgeon, physician assistants, and registered nurses specializing in intravenous therapy comprise the service. From November 1990 through June 1995, the CVAS was consulted for 1,008 PCVC procedures--853 primary insertion attempts and 155 guidewire exchanges. Various types of catheters were inserted for hemodialysis, fluid and medication administration, chemotherapy, and total parenteral nutrition. The primary insertion failure rate was 4% (31/853) and the major complication rate was 1% (8/853); major complications consisted of four pneumothoraces and four lymphocutaneous fistulae. Success and complication rates were superior to those previously reported for less experienced operators. The favorable results of this study support the efficacy of a CVAS.