A PROSPECTIVE CLINICO-BACTERIOLOGICAL STUDY OF INTERNAL JUGULAR CANNULATION IN A CRITICAL CARE UNIT

The results of 125 consecutive central venous catheterizations during a six-month period in the critical care unit were prospectively studie d. All the catheters were inserted percutaneously by internal jugular approach and the placement of catheters was confirmed by chest roentge nography while injecting Conray 420. The safety of the technique was e valuated in terms of success and complication rates. Failure rate was only 0.8 per cent, while overall complication rate was 17.6 per cent. Arterial puncture and hematoma were the commonest complications encoun tered in 8 and 4 per cent of the patients respectively. Pneumothorax o ccurred in two patients (1.6%), while misplacement of catheter tip and thrombophlebitis was encountered in 0.8 per cent of all cannulations. No microorganisms were isolated from catheters inserted for less than 5 days. Positive catheter-tip cultures, by quantitative method, were obtained in 41 cases (P< 0.001) of which infected intravenous insert g rowing >10(3) colony forming units, was encountered in 36 (P< 0.001) a nd colonization of the catheter (<10(3) Colony forming units) was seen in 5 cases. Catheter related bacteremia (recovery of the same organis m from the catheter tip and peripheral blood cultures) occurred in 31 of these 41 patients (P<0.01). The study reveals that internal jugular approach is a safe technique for central vein catheterization with ve ry high success rate and fewer complications. However, catheter-relate d bacteremia is a potential threat which is directly related to the nu mber of days the catheter is in central circulation and is totally pre ventable.