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Central nervous system complications of care — Clinical Guidelines

Overview

Central nervous system (CNS) complications in the context of care primarily arise from procedures such as central venous catheterization, influenced by factors like procedural technique, training, and workplace culture. These complications can include immediate risks like pneumothorax and arterial laceration, as well as delayed complications such as infection and thrombosis 19.

Diagnosis

Clinical Presentation: Assess for signs of immediate complications (e.g., chest pain, dyspnea for pneumothorax; bleeding, hematoma for arterial laceration) and delayed complications (e.g., fever, pain, swelling for infection).

Diagnostic Imaging: Chest X-ray for pneumothorax, ultrasound for vascular complications and catheter placement accuracy 10 11 12.

Laboratory Tests: Blood cultures if infection is suspected 19.

Management

Immediate Management: Address immediate complications such as pneumothorax with needle decompression or chest tube insertion, manage arterial lacerations with pressure and possible surgical intervention 19.

Antibiotics: For suspected or confirmed catheter-related infections, initiate broad-spectrum antibiotics guided by culture results 19.

Catheter Removal/Replacement: Remove or replace central lines if complications arise or if infection is confirmed 19.

Ultrasound Guidance: Use ultrasound guidance to improve procedural accuracy and reduce complications 6 10 11 12.

Special Populations

Pediatrics: Increased vigilance for complications like impacted central venous lines; specialized techniques may be required 16.

Elderly: Higher risk of complications due to comorbid conditions; careful monitoring and management essential 19.

Key Recommendations

Utilize Ultrasound Guidance for central venous catheterization to reduce complications such as posterior vessel wall puncture and arterial injury (Evidence: Moderate 6 10 11 12).

Implement Simulation-Based Training to enhance procedural competency among trainees, improving safety and efficiency in central venous access procedures (Evidence: Moderate 5).

Monitor Workplace Culture to mitigate nursing-sensitive outcomes like sickness absence and occupational injuries, which indirectly affect patient care quality (Evidence: Moderate 7).

Adopt Safety Technologies such as reciprocating procedure devices to further reduce risks associated with central venous access (Evidence: Expert opinion 13).

References

1 Metrouh O, Ali H, DeBacker SES, McCarthy CJ, MacLellan C, Palmer MR et al.. The Effect of Time Pressure on Motion Economy and Smoothness of Interventional Radiology Trainee Performance in Simulated Central Venous Line Placement. Cardiovascular and interventional radiology 2024. link 2 Usoro A, Aiwonodagbon B, Strong J, Kivlehan S, Akodu BA, Olufadeji A. Perspectives on the current state of Nigeria's emergency care system among participants of an emergency medicine symposium: a qualitative appraisal. BMJ open 2021. link 3 Molyneux J. Marijuana and Nurses: Career Risks Remain. The American journal of nursing 2021. link 4 Kivlehan SM, Colinet LRF, Edmond C, Song H, Wei C, Rimpel L et al.. Development of a Prehospital Care Rotation for Emergency Medicine Residents in Haiti. Prehospital and disaster medicine 2021. link 5 Griswold S, Fralliccardi A, Boulet J, Moadel T, Franzen D, Auerbach M et al.. Simulation-based Education to Ensure Provider Competency Within the Health Care System. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2018. link 6 Adhikari S, Theodoro D, Raio C, Nelson M, Lyon M, Leech S et al.. Central Venous Catheterization: Are We Using Ultrasound Guidance?. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2015. link 7 Hahtela N, Paavilainen E, McCormack B, Slater P, Helminen M, Suominen T. Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care. Journal of nursing management 2015. link 8 Blanchet K, James P. The role of social networks in the governance of health systems: the case of eye care systems in Ghana. Health policy and planning 2013. link 9 Sasson C, Wiler JL, Haukoos JS, Sklar D, Kellermann AL, Beck D et al.. The changing landscape of america's health care system and the value of emergency medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2012. link 10 Moon CH, Blehar D, Shear MA, Uyehara P, Gaspari RJ, Arnold J et al.. Incidence of posterior vessel wall puncture during ultrasound-guided vessel cannulation in a simulated model. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2010. link 11 Theodoro D, Bausano B, Lewis L, Evanoff B, Kollef M. A descriptive comparison of ultrasound-guided central venous cannulation of the internal jugular vein to landmark-based subclavian vein cannulation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2010. link 12 Blaivas M, Adhikari S. An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance. Critical care medicine 2009. link 13 Gerstein NS, Martin HB, Toma G, Sibbitt RR, Sibbitt WL. Introduction of new safety technologies into central venous access. Journal of clinical anesthesia 2009. link 14 Asouhidou I, Natsis K, Asteri T, Sountoulides P, Vlasis K, Tsikaras P. Anatomical variation of left internal jugular vein: clinical significance for an anaesthesiologist. European journal of anaesthesiology 2008. link 15 Dranove D, Gron A. Effects of the malpractice crisis on access to and incidence of high-risk procedures: evidence from Florida. Health affairs (Project Hope) 2005. link 16 Vettukattil JJ, Thomas E, Salmon AP. Safe retrieval of impacted central venous line. Archives of disease in childhood 2003. link 17 Roth BE. The current health care environment and stages of market development. Gastroenterology clinics of North America 1997. link70327-7) 18 Cardella JF, Cardella K, Bacci N, Fox PS, Post JH. Cumulative experience with 1,273 peripherally inserted central catheters at a single institution. Journal of vascular and interventional radiology : JVIR 1996. link70724-8) 19 Dawood MM, Trebbin WM. Complications associated with central venous cannulation. Hospital practice (Office ed.) 1991. link 20 Johnson F, Gibbons DR. Microprocessors in health care: panacea or more effervescent technology?. Biomedical engineering 1976. link

Central nervous system complications of care