Review Articles

PRACTITIONERS, MANUFACTURERS, AND REGULATORY AGENCIES have long regarded central venous catheters (CVCs) as relatively dangerous, problem-prone devices. Recent attention has been focused primarily on reduction of infectious complications of CVCs. Application of strict aseptic precautions (the so-called ‘‘central-line bundle’’) when placing CVCs effectively has reduced the incidence of catheter-related infection, and Medicare no longer reimburses for costs related to these infections. However, mechanical complications of central venous cannulation remain a significant cause of morbidity and mortality. Data from the American Society of Anesthesiologists Closed Claims Project database have suggested that since 1990, the majority of mechanical complications associated with CVCs are vascular injuries, and ‘‘accidental puncture or laceration’’ is a reportable National Quality Measures Patient Safety Indicator. Fortunately, most vascular injuries from CVCs should be preventable The purpose of this review is to examine evidence-based methods for preventing vascular complications of CVC placement. The diligent application of preventive measures can reduce the incidence of CVC-related vascular injuries to nearly zero. However, the evidence for treating vascular complications also will be examined, since CVC complications, even if infrequent, can be life-threatening. The review will be organized along anatomic lines, because the implications for arterial and venous injuries usually are different and the implications for intrathoracic vascular injuries usually are different from injuries outside of the chest.