Central line mechanical complication rate in emergency medicine patients

Central line (CL) placement in the emergency department (ED) is a common practice. Previously published small-scale studies have quoted mechanical complication rates in emergency medicine patients of 10-15%. Objective: To determine the mechanical complication rate of central venous catheterization in a large (65,000 visits/ year) academic urban ED. Methods: This was a retrospective review of all ED-placed CLs over a three-year period from May 1995 to May 1998. Data were collected as part of a monthly quality assurance project and analyzed using Fisher's exact test (significance = p < 0.05). Central lines were defined as subclavian, internal jugular, femoral, and interosseous lines. Mechanical complication was defined as a pneumothorax, hematoma, line misplacement, or hemothorax. Results: There were 22 complications of a total of 643 CLs placed [complication rate 3.4% (95% CI = 1.9% to 4.8%)]. The complication rate for patients with a confirmatory chest x-ray receiving a subclavian or internal jugular CL (excluding all patients who died prior to x-ray evaluation of CL) was 6.2% (22/355) (95% CI = 3.9% to 9.3%). There were 402 (63%) CLs placed during a code with a complication rate of 2.2% (95% CI = 1.0% to 4.2%), 79% (317/402) medical and 21% (85/ 402) trauma codes. Thirty-seven percent (241) of the CLs were placed on an "elective urgent" basis. Residents placed the majority of CLs (567/643), with a complication rate of 3%. There was no statistically significant difference in complication rates based on level of resident training. Conclusions: The CL mechanical complication rate in the ED at this institution is 3.4%. This is substantially lower than previously reported mechanical complication rates.