Complications of Central Venous Catheters During Pregnancy and Postpartum A Case Series COMMENT

There are numerous indications for the use of central venous catheters. The rate of catheter complications in the general medical and surgical population is estimated to be 15% to 20%. The extent of risk depends on a large number of factors including the study type, anatomic site, population, technique, operator experience, catheter care, and catheter days. Few studies have investigated the risk of catheter complications in pregnancy and postpartum. The true incidence and the magnitude of the risk among women in this population are unclear. The aim of this retrospective case series was to determine the incidence of complications with central venous catheters in an obstetric population and investigate possible risk factors. The participants were 85 pregnant or postpartum women who had been admitted for obstetric care at a tertiary care teaching hospital between 2000 and 2006. A total of 97 central line placements occurred in 85 patients. Individual patient records were analyzed for duration of catheter placement and all subsequent admissions to obtain patient demographic characteristics, indication for placement, and maternal complications. The catheters were placed antepartum in 76% of the women at a gestational age of 24.7 +/- 10.7 weeks. The indications for catheter placement included failed peripheral intravenous access (n = 59, 61%), need for long-term intravenous access (n = 33, 34%), need for hemodynamic monitoring (n = 4, 4%), and patient comfort (n = 1, 1%). Catheter complications occurred in 25% (24/97) of the line placements; 12 of the 24 (50%) were culture-proven line infections. Other catheter complications included mechanical line failure (17%, 4/24), presumed line infection (8%, 2/24), superficial and deep venous thrombosis (8%, 2/24), tissue hematoma (8%, 2/24), cardiac arrhythmia (4%, 1/24), and patient discomfort (4%, 1/24). The investigators conclude from these findings that the high risk of infectious complications should be considered before using central venous catheters in pregnant patients.