Background: Central venous access devices play an integral role in providing long-term venous access. Percutaneous and cut-down techniques have been used with varying complications.
Methods: Between January 1998 and July of 2001, 358 venous access devices were placed at Albert Einstein Medical Center in Philadelphia, Pennsylvania. A retrospective study was performed to compare complications and operative times for 2 methods of catheter insertion.
Results: Overall complication rate was 14%. In lines successfully placed percutaneously, the complication rate was 15% (25 of 163) compared with 11% (16 of 148) in the successful cephalic cut-down group, P = .11. Complications including -- pneumothorax, late catheter transection, and bradycardia -- only occurred in percutaneously placed lines. Mean operative times were similar for both groups.
Comments: Use of the cut-down approach for long-term venous access may result in improved patient safety. The cut-down technique should be considered a safe initial approach for placement of venous access devices.