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.
■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。