From the Guidelines
Common complications of an internal jugular (IJ) catheter left in place include infection, thrombosis, mechanical obstruction, and catheter migration or dislodgement, with catheter-related bloodstream infections (CRBSIs) being particularly concerning, as reported in studies such as 1 and 1.
Common Complications
- Infection: CRBSIs may present with fever, chills, or erythema at the insertion site, and can be reduced with the use of anti-infective agents, such as minocycline and rifampin, as shown in 1.
- Thrombosis: can develop around the catheter, potentially leading to superior vena cava syndrome or pulmonary embolism, and is more common in catheters inserted from the left side with the tip in the subclavian or innominate veins, as noted in 1.
- Mechanical complications: include catheter occlusion from blood clots or medication precipitates, which can prevent medication administration or blood sampling, and catheter migration, which can cause malfunction or vessel erosion.
- Pneumothorax: though primarily an insertion complication, can worsen if undetected in a catheter left long-term.
Prevention and Management
To minimize these risks, IJ catheters should be removed as soon as clinically feasible, insertion sites should be regularly inspected for signs of infection, and sterile technique must be maintained during dressing changes, as recommended in 1 and 1. Daily assessment of catheter necessity is recommended, with prompt removal when no longer required. The use of ultrasound-guided placement and maximal barrier precautions during CVC insertion can also reduce the risk of infection and mechanical complications, as shown in 1 and 1. Additionally, the use of catheters made from less thrombogenic materials, such as silicone or polyurethane, and the placement of the catheter tip in the caudal SVC, can reduce the risk of thrombosis, as noted in 1.
From the Research
Common Complications of Internal Jugular (IJ) Catheter
The common complications of an internal jugular (IJ) catheter left in place include:
- Catheter-related bloodstream infections (CRBSI) 2, 3, 4, 5, 6
- Venous thrombosis 3, 4
- Pneumothorax 5
- Infection at the catheter entry site 6
- Extraluminal catheter seeding resulting from infection of the catheter entry site by microorganisms 6
- Intraluminal contamination due to improper handling of the catheter hub at the time of connection and disconnection of the administration set 6
Risk Factors for Complications
The risk factors for complications associated with IJ catheters include:
- Duration of catheterization 2, 3, 4, 5
- Type of catheter used 3, 4, 5
- Location of catheter placement 3, 4, 5
- Patient population and disease severity 3
- Year of placement and study publication 4
Prevention of Complications
To prevent complications associated with IJ catheters, the following strategies can be employed:
- Appropriate skin disinfection and maximal antiseptic barriers at the time of catheter insertion 6
- Avoiding the internal jugular and femoral veins whenever possible 6
- Strict asepsis in hub handling and protection of hubs against environmental soiling with an antiseptic impregnated gauze at all times 6
- Use of antibiotic and antiseptic-coated catheters, antiseptic hubs, disinfecting caps, and flushing solutions 6