Central venous catheter insertion by a clinical nurse consultant or anaesthetic medical staff: a single-centre observational study

Abstract

Objective: To compare clinical outcomes of elective central venous catheter (CVC) insertions performed by either a clinical nurse consultant (CNC) or anaesthetic medical staff (AMS). Design, setting and participants: Prospective audit of a convenience sample of consecutive CVC insertions between July 2005 and October 2007 at a metropolitan teaching hospital in Sydney, Australia. The sample included all outpatients and inpatients requiring a CVC for either acute or chronic conditions. Main outcome measures: Number of CVC lines inserted; differences between outcomes in the CNC and AMS groups; complications during and after insertion.Results: Over a 28-month period, 245 CVCs were inserted by AMS and 123 by the CNC. The most common indications for CVC placement in both groups were for the treatment of oncology and autoimmune disorders (61%) and for antibiotic therapy (27%). Other indications were parenteral nutrition (2%) and other therapies (10%). There was no significant difference in complications on insertion between the CNC and AMS groups. AMS failed to obtain access in 12 attempted procedures compared with eight by the CNC. The rate of CVCs investigated for infection was twice as high in the AMS group as in the CNC group (19% v 8%). The confirmed catheter-related bloodstream infection (CRBSI) rate was 2.5/1000 catheters in the AMS group and 0.4/1000 catheters in the CNC group (P = 0.04). Conclusion: Insertion outcomes were favourable in both the AMS and CNC groups. Infection outcomes differed between groups, with a higher rate of CRBSI in the AMS group.