Vascular erosion by central venous catheters used for total parenteral nutrition

Abstract

Objective: To establish the incidence of central venous catheter erosion in a patient cohort receiving total parenteral nutrition and to examine risk factors and complications of vascular erosion.

Design and setting: Review of prospectively collected intravenous nutrition service audit records in a tertiary university hospital.

Results: Records of 1,499 patients (2,992 catheters) were studied over the 14 year period 1991-2005. Fisher's exact test was used to determine statistical significance. Five erosions occurred, representing an incidence of 0.17% per catheter or 0.28 per 1,000 catheter days. One of the five patients died from ensuing complications. Mean time to onset of symptoms was 3.6 days following catheter insertion. Symptoms/signs included dyspnoea (n=5), chest pain (n=2) and pleural effusion (n=5). Diagnosis was delayed by a mean of 1.6 days. Three erosions occurred in left subclavian catheters (n=583); two in left internal jugular catheters (n=453). None occurred in right-sided catheters (n=1956). The relative risk of erosion occurring in left-sided catheters compared to right was 2.9 (95% CI 2.76-3.00; p=0.009). There was no statistically significantly greater risk of vascular erosion in subclavian than internal jugular catheters (relative risk 0.9; p=1.0). Older age was a statistically significant risk factor (p=0.009); female sex was not (p=0.18).

Conclusion: In patients receiving total parenteral nutrition via central venous catheters, erosion has an incidence per catheter of 0.17% and is more likely to occur in left-sided catheters and elderly patients.