Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study.

BACKGROUND: Limited data are available on the incidence of mechanical complications after ultrasound-guided central venous catheterisation. We aimed to determine the incidence of mechanical complications in hospitals where real-time ultrasound guidance is clinical practice for central venous access and to identify variables associated with mechanical complications. METHODS: All central venous catheter insertions in patients ≥16 yr at four emergency care hospitals in Sweden from March 2, 2019 to December 31, 2020 were eligible for inclusion. Every insertion was monitored for complete documentation and occurrence of mechanical complications within 24 h after catheterisation. Multivariable logistic regression analyses were used to determine associations between predefined variables and mechanical complications. RESULTS: In total, 12 667 catheter insertions in 8586 patients were included. The incidence (95% confidence interval [CI]) of mechanical complications was 7.7% (7.3-8.2%), of which 0.4% (0.3-0.5%) were major complications. The multivariable analyses showed that patient BMI <20 kg m-2 (odds ratio 2.69 [95% CI: 1.17-5.62]), male operator gender (3.33 [1.60-7.38]), limited operator experience (3.11 [1.64-5.77]), and increasing number of skin punctures (2.18 [1.59-2.88]) were associated with major mechanical complication. Subclavian vein catheterisation was associated with pneumothorax (5.91 [2.13-17.26]). CONCLUSIONS: The incidence of major mechanical complications is low in hospitals where real-time ultrasound guidance is the standard of care for central venous access. Several variables independently associated with mechanical complications can be used for risk stratification before catheterisation procedures, which might further reduce complication rates. CLINICAL TRIAL REGISTRATION: NCT03782324.

Cystatin C and derived measures of renal function as risk factors for mortality and acute kidney injury in sepsis - A post-hoc analysis of the FINNAKI cohort.

PURPOSE: To assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis. MATERIALS AND METHODS: Post-hoc analysis of sepsis patients in the FINNAKI-cohort (n = 802). Primary outcome was 90-day mortality. We measured plasma cystatin C and creatinine at intensive care unit (ICU) admission and estimated glomerular filtration rates (eGFRcys, eGFRcrea) and shrunken pore syndrome (SPS; defined as eGFRcys/eGFRcrea ratio < 0.7). Associations were assessed using Cox- or logistic regression. RESULTS: Increased cystatin C and decreased eGFRcys were associated with mortality in unadjusted analyses and in analyses adjusted for illness severity and creatinine. Hazard ratios (HRs) in unadjusted analyses were 3.30 (95% CI; 2.12-5.13, p < 0.001) and 3.26 (95% CI; 2.12-5.02, p < 0.001) respectively. SPS was associated with mortality in an unadjusted- (HR 1.78, 95% CI; 1.33-2.37, p < 0.001) and in an adjusted analysis (HR 1.54, 95% CI; 1.07-2.22, p = 0.021). All cystatin C-derived measures were associated with mortality also after adjustment for AKI development. Cystatin C was associated with AKI in unadjusted analyses but not in analyses adjusted for creatinine. CONCLUSION: Cystatin C and derived measures of kidney function at ICU admission are associated with an increased 90-day mortality. Increased AKI incidence does not fully explain this association.

Efficacy of an implementation package on documentation of central venous catheter insertions: an observational study.

BACKGROUND: Proper documentation of central venous catheter (CVC) insertions in electronic healthcare records is the basis for good follow-up and quality assurance. We have noted serious deficiencies in the documentation of CVC insertions and introduced an implementation package with the purpose of increasing the completeness of this documentation. The aim of the present study was to estimate the effect of the implementation package by assessing the proportion of missing data before and after the introduction of the implementation package. METHODS: In this single centre observational study, data from CVC insertion templates in a common electronic health record were extracted and analysed after introducing the implementation package. The package included adoption of new local CVC-directions, a new updated CVC-insertion template in the regional common electronic health record and a review of all CVC-insertion templates with a reminder to the inserting physician to supplement missing data. The proportion of terms with missing data was reviewed and also compared with the proportion of missing data in a study prior to the introduction of the package. RESULTS: In total, 7126 CVC-insertion templates were included. Of these 5539 (78%) were without missing data for any of the 13 predefined variables. Completed insertion templates for three common terms increased from 38% prior to the introduction of the implementation package to 93%, which represents an absolute reduction for missing data of 55% (95% CI 53% to 56%, p<0.0001). CONCLUSION: The implementation package was highly effective in increasing the proportion of fully documented CVC insertions.