Abstract：
UNASSIGNED: Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions.
UNASSIGNED: To summarize current rates of CVC-associated complications.
UNASSIGNED: MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023.
UNASSIGNED: This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded.
UNASSIGNED: Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated.
UNASSIGNED: Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed.
UNASSIGNED: Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters).
UNASSIGNED: Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.
UNASSIGNED: To summarize current rates of CVC-associated complications.
UNASSIGNED: MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023.
UNASSIGNED: This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded.
UNASSIGNED: Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated.
UNASSIGNED: Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed.
UNASSIGNED: Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters).
UNASSIGNED: Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.
摘要：
■中心静脉导管（CVC）是常用的，但与并发症有关。量化并发症发生率对于指导CVC利用决策至关重要。
■总结当前CVC相关并发症的发生率。
■MEDLINE,Embase,CINAHL,在CENTRAL数据库中搜索了2015年至2023年间发表的观察性研究和随机临床试验.
■本研究包括英语观察性研究和成年患者的随机临床试验，这些研究报告了短期中央插入性CVC的并发症发生率和1个或多个目标结局的数据。评估长期血管内装置的研究，专注于通常不用于药物管理的透析导管，或由放射科医师放置的研究导管被排除.
■两名评审员独立提取数据并评估偏倚风险。贝叶斯随机效应荟萃分析用于总结事件发生率。估计了放置并发症（事件/1000个导管，95%可信间隔[CrI]）和使用并发症（事件/1000个导管天，95%CrI）的发生率。
■与CVC放置相关的十种预设并发症（放置失败，动脉穿刺,动脉插管,气胸,出血事件需要采取行动，神经损伤,动静脉瘘,心脏填塞,心律失常,血管加压药给药延迟≥1小时）和5种与CVC使用相关的预设并发症（功能障碍，感染,深静脉血栓形成[DVT]，血栓性静脉炎,和静脉狭窄）进行评估。4种严重并发症的复合（动脉插管，气胸,感染,或DVT）在CVC暴露3天后也进行了评估。
■在11722项筛选研究中，130人被纳入分析。对15种预设并发症中的7种进行了荟萃分析。放置失败发生在20.4(95%CrI，10.9-34.4)每放置1000个导管的事件。CVC置入并发症的其他发生率（每1000根导管）为动脉插管（2.8；95%CrI，0.1-10),动脉穿刺（16.2；95％CrI，11.5-22),和气胸（4.4；95%CrI，2.7-6.5)。CVC使用并发症的发生率（每1000个导管天）为故障（5.5；95%CrI，0.6-38),感染（4.8；95%CrI，3.4-6.6),和DVT(2.7；95%CrI，1.0-6.2)。据估计，30.2(95%CrI，21.8-43.0）在1000例CVC持续3天的患者中，会出现1种或更严重的并发症（动脉插管，气胸,感染,或DVT)。使用超声检查与较低的动脉穿刺率相关(风险比[RR]，0.20;95%CrI,0.09-0.44；13.5事件vs68.8事件/1000导管）和气胸（RR，0.25;95%CrI,0.08-0.80；2.4事件vs9.9事件/1000导管）。
■大约3%的CVC植入与主要并发症相关。使用超声引导可以降低特定风险，包括动脉穿刺和气胸。
■总结当前CVC相关并发症的发生率。
■MEDLINE,Embase,CINAHL,在CENTRAL数据库中搜索了2015年至2023年间发表的观察性研究和随机临床试验.
■本研究包括英语观察性研究和成年患者的随机临床试验，这些研究报告了短期中央插入性CVC的并发症发生率和1个或多个目标结局的数据。评估长期血管内装置的研究，专注于通常不用于药物管理的透析导管，或由放射科医师放置的研究导管被排除.
■两名评审员独立提取数据并评估偏倚风险。贝叶斯随机效应荟萃分析用于总结事件发生率。估计了放置并发症（事件/1000个导管，95%可信间隔[CrI]）和使用并发症（事件/1000个导管天，95%CrI）的发生率。
■与CVC放置相关的十种预设并发症（放置失败，动脉穿刺,动脉插管,气胸,出血事件需要采取行动，神经损伤,动静脉瘘,心脏填塞,心律失常,血管加压药给药延迟≥1小时）和5种与CVC使用相关的预设并发症（功能障碍，感染,深静脉血栓形成[DVT]，血栓性静脉炎,和静脉狭窄）进行评估。4种严重并发症的复合（动脉插管，气胸,感染,或DVT）在CVC暴露3天后也进行了评估。
■在11722项筛选研究中，130人被纳入分析。对15种预设并发症中的7种进行了荟萃分析。放置失败发生在20.4(95%CrI，10.9-34.4)每放置1000个导管的事件。CVC置入并发症的其他发生率（每1000根导管）为动脉插管（2.8；95%CrI，0.1-10),动脉穿刺（16.2；95％CrI，11.5-22),和气胸（4.4；95%CrI，2.7-6.5)。CVC使用并发症的发生率（每1000个导管天）为故障（5.5；95%CrI，0.6-38),感染（4.8；95%CrI，3.4-6.6),和DVT(2.7；95%CrI，1.0-6.2)。据估计，30.2(95%CrI，21.8-43.0）在1000例CVC持续3天的患者中，会出现1种或更严重的并发症（动脉插管，气胸,感染,或DVT)。使用超声检查与较低的动脉穿刺率相关(风险比[RR]，0.20;95%CrI,0.09-0.44；13.5事件vs68.8事件/1000导管）和气胸（RR，0.25;95%CrI,0.08-0.80；2.4事件vs9.9事件/1000导管）。
■大约3%的CVC植入与主要并发症相关。使用超声引导可以降低特定风险，包括动脉穿刺和气胸。
