German Point Prevalence Study on CVC

Study Overview
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Brief Summary
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It has now been 90 years since Werner Forssmann developed the CVC. Nowadays CVCs play an integral role for critically ill patients. Despite the high number of central venous access devices inserted annually, there are limited data on the incidence of the associated procedural complications, many of which carry substantial clinical risk. This point was highlighted in recently published Association of Anaesthetists of Great Britain and Ireland Safe vascular access 2016 guidelines and Clinical guidelines on central venous catheterisation in 2014 of the Swedish Society of Anaesthesiology and Intensive Care Medicine. This German point prevalence study should identify the number of central venous catheter insertions and the incidence of various and especially serious mechanical complications across multiple hospital sites within one day. Secondary aims are to identify the availability of resources and infrastructure to facilitate safe central venous catheter insertion and management of potential complications. As much hospital sites as possible should participate and identify all adult central venous catheter insertions, with subsequent review of any complications detected. Additionally, resources while inserting the CVC should be specified such as ultrasound for assessment of ultrasound anatomy and/or ultrasound-guidance. Furthermore, assessment of the CVC tip should be studied whether done during CVC placement with ECG-guidance or by transthoracic/transesophageal ultrasound with the Microbubble test or more conventional post hoc with bedside chest X-ray Any mechanical complication should be documented untill day three post insertion. The background is to identify possible perforations due to initially unfavorable CVC tip positions (angle > 40 ° to wall of the superior vena cava). Participation in the study is open to all disciplines (anesthesia, intensive care, internal medicine, surgery, etc.) that regularly perform CVCs.

Detailed Description
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Questions How experienced are the CVC operators? What are the demographics of the patients included? How many emergency patients will be included in the study? How is the distribution of the punctured vessels and that of the respective sides? How many puncture attempts are necessary to achieve a successful CVC placement and how often do problems with the Seldinger-wire occur? How often is ultrasound used to place a CVC and if so, Only for Screening? Puncture under ultrasound view? What is the distribution between short and long axis view? What catheter types and which caliber in French are being inserted? Catheter position control: by EKG-lead on Pmax or Pmax - x cm (withdroth) by means of transthoracic ultrasound and agitated NaCl solution by means of transesophageal echocardiography and NaCl solution by means of X-ray image other or missing position control Statement on the position of the CVC tip How common are CVC-malpositions and what is their distribution? Which complications occur within 72 h? Which measures do you require and how do they affect the respective patient?

Official Title
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German Point Prevalence Study on Central Venous Catheter

Conditions
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Data Collection

Intervention / Treatment
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* Other: central venous catheter insertion


Participation Criteria
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Eligibility Criteria
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Age Inclusion criteria: Adults Young Adults Children Infants Neonates Exclusion criteria: None Procedures Inclusion criteria: Elective central venous access procedures Emergency central venous access procedures Exclusion criteria: None Providers Inclusion criteria: Anesthesiologists Internist Neurologist Surgeon Etc. Exclusion criteria: None Selection of catheter insertion site External jugular Internal jugular Subclavian Femoral Complications Inclusion criteria: Arterial cannulation/injury/cerebral embolization/hemorrhage Catheter or wire shearing or loss Lacerations of great vessels Exsanguination Hemo/pneumothorax; peritoneal hemorrhage Pneumothorax Tamponade Tracheal injury Air embolism Heart puncture (tamponade) Hemothorax Stroke Mortality Number of attempts at central line placement Failed insertion attempts Successful, nontraumatic procedure Wire, needle, catheter issues Exclusion criteria: Infections or other complications not associated with central venous catheterization Mechanical injury or trauma not associated with central venous catheterization
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: central venous catheter insertion|Every operator should perform the CVC Insertion Procedure according to his common clinical practice.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients Demographics | All patients with a CVC Insertion on May 17th. 2022 in participating Hospitals independent of sex, age or BMI in kg/m^2 are eligible | 17.05.2022 | 
| Complications and malpositions | Which complications and malpositions occur within 72 h | 17.05.2022-20.05.2022 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of the emergency procedure | How many emergency patients will be included in the study | 17.05.2022 | 
| Distribution of the vessel sites und sides | distribution of the punctured vessels (external jugular, internal jugular, subclavian, femoral ) and that of the respective sides | 17.05.2022 | 
| Experience of the operator | Resident physician/ Specialist doctor | 17.05.2022 | 
| Puncture attempts | How many puncture attempts are necessary to achieve a successful CVC | 17.05.2022 | 
| Type and caliber of catheter | What catheter types and which caliber in French are being inserted | 17.05.2022 | 
| Wire problems/issues | witch and how often do problems with the Seldinger-wire occur | 17.05.2022 | 
| Ultrasound assistance | Screening / Online guidance / Short or long axis view | 17.05.2022 | 
| CVC tip position | measures to ensure central venous catheter tip position (i.e. CXR, ECG method and ultrasound) | 17.05.2022 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Central venous catheter, central venous line, Catheterization, Central Venous / access, Catheterization, Central Venous / methods, Catheterization, Central Venous / instrumentation, Catheterization, Central Venous / adverse effects, Placement of larger catheters, Insertion of CVCs, Complication of CVCs, CVC misplacement, Ultrasonography, Interventional / adverse effects, Ultrasonography, Interventional / instrumentation, Ultrasonography, Interventional / methods, Electroctrocardiography, Radiography, Echocardiographie/ TEE, Vascular Access Devices / standards, Vascular Access Devices / trends, Critical Illness / therapy, Humans, Adults, Adolescents