Central venous catheterization tip position and immediate complications: Influence of various routes and skill of anaesthetists

Central venous catheterization is a commonly employed procedure by the anaesthetists in the intensive care unit and the operating room. It is associated with malpositioning and several immediate complications. In a prospective study we evaluated the position of the tip of the catheter, immediate complications and selection of route of catheterization by different anaesthetists to see whether the skill of the anaesthetist influences the choice of route of insertion of central venous catheter. The results showed that the tip positioning was similar to that reported in literature except for a little less success in the internal jugular vein route. This was because the junior anaesthetists had high incidence of malpositioning through this route. In our study the junior anaesthetists were more inclined to use antecubital veins for central venous catheterization whereas senior anaesthetists were more inclined towards neck veins. Success rate for correct placement of catheters can be increased and complication rate although small can be further reduced if the less experienced anaesthetists are restricted from using neck veins while the success rate and the complication rate for antecubital route was not affected by the skill of the anaesthetists.