Central Line Catheters and Associated Complications: A Review

Exploring Extravasation in Cancer Patients

Extravasation, the unintended leakage of intravenously administered substances, poses significant challenges in cancer treatment, particularly during chemotherapy and radiotherapy. This comprehensive review explores the pathophysiology, incidence, risk factors, clinical presentation, diagnosis, prevention strategies, management approaches, complications, and long-term effects of extravasation in cancer patients. It also outlines future directions and research opportunities, including identifying gaps in the current knowledge and proposing areas for further investigation in extravasation prevention and management. Emerging technologies and therapies with the potential to improve extravasation prevention and management in both chemotherapy and radiotherapy are highlighted. Such innovations include advanced vein visualization technologies, smart catheters, targeted drug delivery systems, novel topical treatments, and artificial intelligence-based image analysis. By addressing these aspects, this review not only provides healthcare professionals with insights to enhance patient safety and optimize clinical practice but also underscores the importance of ongoing research and innovation in improving outcomes for cancer patients experiencing extravasation events.

Pitfalls in internal jugular vein cannulation

Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased use of ultrasound in healthcare settings. Despite the increased safety profile and insertion convenience, it has complications. Herein, we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.

Comparing commercial versus low-cost gelatinous phantoms for ultrasound-guided needle tracking: A randomized crossover trial, among emergency medicine residents

OBJECTIVES

The objective of this study was to devise a low-cost indigenous gelatin-based vascular phantom and to compare this newly constructed phantom with a commercially available phantom.

METHODS

This was a randomized crossover study conducted at a tertiary care hospital of India. The aim of the study was to develop a prototype low-cost gelatin-based vascular phantom and compare it with a commercially available phantom. Gelatin, psyllium husk, corn starch, antiseptic liquid, food-coloring agent, latex balloons, and metallic containers were used to prepare the gelatin phantom. The newly prepared gelatin model was labeled "Model A" and the commercially available gelatin model was labeled "Model B." Emergency medicine residents (n = 34) who routinely perform ultrasound (USG)-guided invasive procedures were asked to demonstrate USG-guided in-plane and out-of-plane approach of needle-tracking in both the models and fill out a questionnaire on a Likert scale (1-5). An independent supervisor assessed the image quality.

RESULTS

The cost of our phantom was USD 6-8 (vs. USD 1000-1200 for commercial phantom). The participants rated the ease of performance and tissue resemblance as 4 (interquartile range [IQR]: 4-5) for both the models "A" and "B." The supervisor rated the overall performance as 4 (IQR: 3-4) for both the models. In all the parameters assessed, model A was noninferior to model B.

CONCLUSION

The indigenously developed vascular phantom was noninferior to the commercially available phantom in terms of tissue resemblance and overall performance. The cost involved was a fraction of that incurred with the currently available commercial model. The authors feel that gelatin-based models can be easily prepared in resource-constraint settings which may be used for USG-guided training and medical education in low- and middle-income countries.

Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study

Background

Central venous catheters are essential for management of hospitalized patients, but their insertion is subject to complications that can make them unusable and/or cause patient morbidity. There are few data on the incidence of these complications and the variables associated with these outcomes in Brazil.

Objectives

To determine the incidence of mechanical complications and failures of short stay central venous catheters fitted by the vascular surgery service at a teaching hospital and identify variables associated with their occurrence.

Methods

This was a prospective cohort of 73 attempts to fit patients with a central venous catheter performed by the vascular surgery service at a teaching hospital from July to October of 2022.

Results

Mechanical complications occurred in 12 cannulation attempts (16.44%) and there were 10 failures (13.70%). The factors associated with mechanical complications were less experienced operators (p < 0.001), less specialized operators (p = 0.014), a failed attempt prior to requesting help from the vascular surgery service (p = 0.008), and presence of at least two criteria for difficulty (p = 0.007).

Conclusions

The local incidence of mechanical complications and central venous cannulation failures was similar to rates described in the international literature, but higher than rates in other Brazilian studies. The results suggest that the degree of experience of the person fitting the catheter, history of a failed prior attempt, and presence of at least two criteria for difficulty identified before the procedure were associated with worse outcomes.

Anesthetic Considerations for Cardiac Tamponade after Internal Jugular Central Line Placement during Trauma Resuscitation: A Case Report

Numerous complications are associated with central venous catheters. Among them, cardiac tamponade is a rare but well-documented catastrophic complication. A 22-year-old healthy male presented with Code 1 trauma resulting from gunshot wounds in the abdomen. Upon examination, he was found to have a large pericardial fluid collection, a large right supraclavicular hematoma, and significant amount of bilateral pleural effusions secondary to extraluminal placement of the right internal jugular central line during resuscitation. After repairing the internal jugular injury and draining the pericardial fluid, the patient was transferred from the intensive care unit to the regular hospital floor. However, 15 days later, imaging revealed re-accumulation of a large pericardial effusion, which was eventually treated with a pericardial window operation. This case report explores potential complications that could arise from central line placement and the anesthetic considerations in a patient with cardiac tamponade from extraluminal central line placement.

Procedure Code Utilization for Vascular Access Device Placement in the Inpatient Setting: A Retrospective Analysis

Vascular access (VA) is essential to inpatient care, and the documentation/coding practices for vascular access device (VAD) placement procedures remain unexplored. Accurate documentation may present benefits for patients, providers, and researchers. A retrospective analysis was performed in adult inpatients (2015 to 2020) using Cerner Real World Data™ to evaluate the utilization of CPT codes for VAD placement/replacement procedures. A total of 14,253,584 patient encounters were analyzed, 0.111 percent (n=15,833) of which received at least one VAD procedure code. Non-tunneled CVC procedures had the highest code rate (0.067 percent), while PIV/midline procedures were the least likely to be coded (0.004 percent). The annual proportion of code utilization increased from 10.9 percent in 2015 to 19.7 percent in 2020 (p<0.0001). Despite widespread use of VADs in the inpatient setting, the procedure coding rate was found to be remarkably low. Appropriate coding/documentation practices may ensure proper care by capturing VA-related patient history, and improve research quality and resource/staff allocation.

Intraperitoneal Hematoma After Femoral Catheterization: A Case Report and Literature Review

Central venous catheters (CVCs) are often crucial in managing severely ill patients, especially those in the intensive care unit. It is estimated that over 5 million CVCs are inserted per year in the United States. The internal jugular, subclavian, or femoral veins are the most used access sites. The catheter is advanced until its tip lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Unfortunately, the use of CVCs is not without its drawbacks, and multiple immediate and delayed complications have been described. Herein, we report a case of a 70-year-old female with a past medical history significant for chronic obstructive pulmonary disease, coronavirus disease 2019, pneumonia, type 2 diabetes mellitus, and hypertension, who presented to the emergency department from a skilled nursing facility with a two-day history of dyspnea. She was later diagnosed with an intraperitoneal hematoma, an uncommon complication caused by a CVC placement.

A Multidisciplinary Approach and Development of an Algorithm for Timely Repair of Central Venous Access in Pediatric Patients

Background: Central venous catheters (CVCs) carry a risk for many complications. This can lead to numerous and prolonged hospitalizations for patients undergoing intravenous nutrition. The aim was to create a standardized protocol for the medical facility to expedite the repair process as well as implement a broadened educational effort for the care of CVCs.

Method: A retrospective chart review was completed for 365 catheter days before implementation. Two protocols were then created in collaboration with the multidisciplinary team. Prospective chart data were subsequently collected 365 catheter days post-implementation.

Result: Pre-implementation (32 encounters), 100% of compromised CVCs required admission. Post-implementation (21 encounters), only 48% of compromised CVCs required admission accompanied by an overall reduction in the number of compromised catheters that presented to the hospital. The average hospital length of stay pre-protocol initiation decreased from 7.2 to 1.8 days post-protocol initiation. The implementation of our algorithm also lead to a decrease in the average cost of compromised CVC repair inpatient ($2741) vs repair in the emergency department ($34,436).

Conclusion: This study demonstrates that working with a multidisciplinary team utilizing a standardized protocol improved the quality of patient care by decreasing hospital admissions for compromised CVCs. The authors also conclude that the expedited repair of CVCs can help alleviate health care costs for both families and the hospital system.

Superior vena cava perforation complicating ultrasound-guided subclavian venous catheterization: A case report

We present a case of a severe mechanical complication (superior vena cava [SVC] perforation) that developed after subclavian vein catheterization using an ultrasound-guided static approach in a patient who underwent right lower lobectomy with video-assisted thoracic surgery. The use of ultrasound during catheterization is reported to reduce mechanical complications. Despite the use of ultrasound in our patient, surgical exploration showed that the catheter placed in the right subclavian vein penetrated the superior portion of the SVC. At the end of the surgery, the catheter was removed under direct visualization. The surgeon attempted to stop bleeding in the SVC by compressing with gauze. However, bleeding could only be stopped by administering a hemostatic matrix. It is concluded that to reduce the incidence or size of iatrogenic perforation of the SVC, catheters with the smallest possible diameter should be used, and the dilator should only be inserted deep enough to enter the vein. If the static approach is used, the modifiedSeldinger technique is useful and to provide training to improve the ultrasound experience, especially if the dynamic approach is used.

Hypochlorous Acid-Generating Electrochemical Catheter Prototype for Prevention of Intraluminal Infection

Central line-associated bloodstream infection (CLABSI) contributes to mortality and cost. While aseptic dressings and antibiotic-impregnated catheters prevent some extraluminal infections, intraluminal infections remain a source of CLABSIs. In this proof-of-concept study, an electrochemical intravascular catheter (e-catheter) prototype capable of electrochemically generating hypochlorous acid intraluminally using platinum electrodes polarized at a constant potential of 1.5 electrode potential relative to saturated silver/silver chloride reference electrode measured in volts (V_Ag/AgCl) was developed. After 24 h of prepolarization at 1.5 V_Ag/AgCl, their activity was tested against clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, and Escherichia coli derived from catheter-related infections. e-catheters generated a mean HOCl concentration of 15.86 ± 4.03 μM and had a mean pH of 6.14 ± 0.79. E-catheters prevented infections of all four species, with an average reduction of 8.41 ± 0.61 log₁₀ CFU/ml at 48 h compared to controls. Polarized e-catheters which generate low amounts of HOCl continuously should be further developed to prevent intraluminal infection. IMPORTANCE Catheter-related infections constitute an economic and mortality burden in health care. Several options are available to reduce the risk of infection, but only a few focus on preventing intraluminal infection, which occurs in long-term catheters, most often used for dialysis, prolonged treatment, or chemotherapy. A prototype of a catheter called an "e-catheter" composed of three electrodes, capable of producing hypochlorous acid (HOCl) electrochemically in its lumen, was developed. When polarized at 1.5 V, chloride ions in the solution are oxidized to continuously produce low amounts of HOCl, which exhibits antibacterial activity in the lumen of the catheter. Here, this prototype was shown to be able to generate HOCl as well as prevent infection in a preliminary in vitro catheter model. This approach is a potential strategy for catheter infection prevention.

Experience in the use of midclavicular catheters: An inception cohort study

AIMS AND OBJECTIVES

To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal.

BACKGROUND

Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length.

DESIGN

Inception cohort study.

METHODS

We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed.

RESULTS

Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure.

CONCLUSIONS

Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal.

RELEVANCE TO CLINICAL PRACTICE

Midclavicular lines are a safe alternative for intravenous therapy lasting more than 6 days, even with irritant drugs.

Spontaneous Knot Formation in a Central Venous Catheter

Patient: Male, 63-year-old

Final Diagnosis: Spontaneous knot formation in central venous catheter

Symptoms: Central venous catheter whit any flow • associated with pain at the insertion site of the access

Medication: —

Clinical Procedure: Central venous catheterization

Specialty: General and Internal Medicine • Surgery

Infectious complications of CAR T-cell therapy: a clinical update

Chimeric antigen receptor (CAR) T-cell therapy is a revolutionary treatment modality used to treat haematological malignancies. Lymphocytes are engineered to produce CARs directed towards tumour cell antigens. Clinical trials have demonstrated impressive malignancy-related outcomes. Unfortunately, numerous off-target effects can cause toxicity-related adverse events in this population, the main being cytokine release syndrome and immune effector cell neurotoxicity syndrome. This causes significant patient morbidity and poor outcomes. Patients who receive CAR T-cell therapy are also profoundly immunosuppressed and often cytopenic, which is caused by a multitude of patient- and treatment-related factors. Thus, infection-related complications are also common in this group. Indeed, up to one third of patients will suffer a serious bacterial infection in the first 30 days after therapy. Viral respiratory tract infection appears to be the most common during the late phase and can be severe; one patient has died of influenza A infection. Fungal infection and cytomegalovirus (CMV) reactivation appear to be uncommon. Although institutional guidelines on infection-prevention strategies are available, there is a dearth of evidence to support their approach. Future research needs to target important unanswered questions that remain in this patient population in order to improve their short- and long-term outcomes.

Novel Wire-Guided Scalpel to Facilitate Central Venous Catheter Insertion without a Skin Bridge

Central venous catheter (CVC) placement is a commonly performed procedure. More than 5 million CVC placements are performed annually in the United States, with nearly 45% of critical care patients and 8% of all inpatients requiring a CVC during their hospitalization. A novel wire-guided scalpel (GuideBlade; Ambitus Medical Supplies LLC, Oceanside, NY, USA) has recently been introduced into clinical practice. In this communication, we will describe how to use the device and discuss possible advantages associated with its routine use during CVC placement.

Joint time-frequency analysis of visible laser reflections in a sheep heart

Limited methods exist to confirm the position of cardiovascular devices in the superior vena cava or right atrium of the heart. The aim of this study was to design, test and validate the feasibility of whether an optical fiber-based instrument could accurately distinguish when a cardiovascular catheter was located in the superior vena cava vs in the right atrium. An optical fiber was placed in a cardiovascular catheter which was inserted into a living sheep and guided to the vicinity of the heart where diode laser-based reflection intensity data were simultaneously gathered from two visible wavelengths of light reflected from the venous and atrial tissue surfaces near the cavoatrial junction. The time series data were postoperatively analyzed using methods of joint time-frequency analysis and validated against catheter positions determined with fluoroscopy and ECG. The system was successful in distinguishing the location of the superior vena cava from the right atrium.

Acute ischaemia of the upper limb following peripherally inserted central catheter-a venous to arterial complication cascade

Peripherally inserted central catheters (PICC) are useful access devices that allow for longer-term intravenous access. This allows patients requiring an extended period of intravenous medication to have this administered without the need for repeat vascular punctures. Even minimally invasive procedures such as line insertion come with risks. Of particular interest to this article is a limb threatening complication soon after line placement. We discuss the PICC line catheter tip as the likely cause for arrhythmia that lead to an embolic occlusion of an upper limb and required acute surgical intervention for limb salvage. We stress the rapid sequence of events that lead to this ultimate complication. We also stress the importance for all clinicians to be aware of these risks and take a cautious approach as the majority of patients requiring longer-term access are already at greater risks of thromboembolic disease due to their comorbidities.

[Some aspects of iatrogenic vessel injury]

Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.

A Continuous Cuffless Blood Pressure Estimation Using Tree-Based Pipeline Optimization Tool

High blood pressure (BP) may lead to further health complications if not monitored and controlled, especially for critically ill patients. Particularly, there are two types of blood pressure monitoring, invasive measurement, whereby a central line is inserted into the patient’s body, which is associated with infection risks. The second measurement is cuff-based that monitors BP by detecting the blood volume change at the skin surface using a pulse oximeter or wearable devices such as a smartwatch. This paper aims to estimate the blood pressure using machine learning from photoplethysmogram (PPG) signals, which is obtained from cuff-based monitoring. To avoid the issues associated with machine learning such as improperly choosing the classifiers and/or not selecting the best features, this paper utilized the tree-based pipeline optimization tool (TPOT) to automate the machine learning pipeline to select the best regression models for estimating both systolic BP (SBP) and diastolic BP (DBP) separately. As a pre-processing stage, notch filter, band-pass filter, and zero phase filtering were applied by TPOT to eliminate any potential noise inherent in the signal. Then, the automated feature selection was performed to select the best features to estimate the BP, including SBP and DBP features, which are extracted using random forest (RF) and k-nearest neighbors (KNN), respectively. To train and test the model, the PhysioNet global dataset was used, which contains 32.061 million samples for 1000 subjects. Finally, the proposed approach was evaluated and validated using the mean absolute error (MAE). The results obtained were 6.52 mmHg for SBS and 4.19 mmHg for DBP, which show the superiority of the proposed model over the related works.

Individualizing Therapy in CIDP: A Mini-Review Comparing the Pharmacokinetics of Ig With SCIg and IVIg

Immunoglobulin (Ig) therapy is a first-line treatment for CIDP, which can be administered intravenously (IVIg) or subcutaneously (SCIg) and is often required long term. The differences between these modes of administration and how they can affect dosing strategies and treatment optimization need to be understood. In general, the efficacy of IVIg and SCIg appear comparable in CIDP, but SCIg may offer some safety and quality of life advantages to some patients. The differences in pharmacokinetic (PK) profile and infusion regimens account for many of the differences between IVIg and SCIg. IVIg is administered as a large bolus every 3–4 weeks resulting in cyclic fluctuations in Ig concentration that have been linked to systemic adverse events (AEs) (potentially caused by high Ig levels) and end of dose “wear-off” effects (potentially caused by low Ig concentration). SCIg is administered as a smaller weekly, or twice weekly, volume resulting in near steady-state Ig levels that have been linked to continuously maintained function and reduced systemic AEs, but an increase in local reactions at the infusion site. The reduced frequency of systemic AEs observed with SCIg is likely related to the avoidance of high Ig concentrations. Some small studies in immune-mediated neuropathies have focused on serum Ig data to evaluate its potential use as a biomarker to aid clinical decision-making. Analyzing dose data may help understand how establishing and monitoring patients' Ig concentration could aid dose optimization and the transition from IVIg to SCIg therapy.

A Glance at Antimicrobial Strategies to Prevent Catheter-Associated Medical Infections

Urinary and intravascular catheters are two of the most used invasive medical devices; however, microbial colonization of catheter surfaces is responsible for most healthcare-associated infections (HAIs). Several antimicrobial-coated catheters are available, but recurrent antibiotic therapy can decrease their potential activity against resistant bacterial strains. The aim of this Review is to question the actual effectiveness of currently used (coated) catheters and describe the progress and promise of alternative antimicrobial coatings. Different strategies have been reviewed with the common goal of preventing biofilm formation on catheters, including release-based approaches using antibiotics, antiseptics, nitric oxide, 5-fluorouracil, and silver as well as contact-killing approaches employing quaternary ammonium compounds, chitosan, antimicrobial peptides, and enzymes. All of these strategies have given proof of antimicrobial efficacy by modifying the physiology of pathogens or disrupting their structural integrity. The aim for synergistic approaches using multitarget processes and the combination of both antifouling and bactericidal properties holds potential for the near future. Despite intensive research in biofilm preventive strategies, laboratorial studies still present some limitations since experimental conditions usually are not the same and also differ from biological conditions encountered when the catheter is inserted in the human body. Consequently, in most cases, the efficacy data obtained from in vitro studies is not properly reflected in the clinical setting. Thus, further well-designed clinical trials and additional cytotoxicity studies are needed to prove the efficacy and safety of the developed antimicrobial strategies in the prevention of biofilm formation at catheter surfaces.

The Boston Medical Center Coronavirus Disease 2019 (COVID-19) Procedure Team: Optimizing the surgeon's role in pandemic care at a safety-net hospital

Background

The coronavirus disease 2019 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center, a regional safety-net hospital, the Department of Surgery created a dedicated coronavirus disease 2019 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in coronavirus disease 2019 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams.

Methods

Procedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment. Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated surgeon-led team would perform invasive bedside procedures expeditiously and with few complications.

Results

From March 30, 2020 to April 30, 2020, there were 1,196 coronavirus disease 2019 admissions. The Procedure Team performed 272 procedures on 125 patients, including placement of 135 arterial catheters, 107 central venous catheters, 25 hemodialysis catheters, and 4 thoracostomy tubes. Specific to central venous access, the average procedural time was 47 minutes, and the rate of immediate complications was 1.5%, including 1 arterial cannulation and 1 pneumothorax.

Conclusion

Procedural complication rate was less than rates reported in the literature. The team saved approximately 192 hours of work that could be redirected to other patient care needs. In times of crisis, redeployment of surgeons (who arguably have the most procedural experience) into procedural teams is a practical approach to optimize outcomes and preserve resources.

Retrospective analysis of central venous catheters in elective intracranial surgery - Is there any benefit?

Background

It remains unclear whether the use of central venous catheters (CVC) improves a patient's clinical outcome after elective intracranial supratentorial procedures.

Methods

This two-armed, single-center retrospective study sought to compare patients undergoing elective intracranial surgery with and without CVCs. Standard anaesthesia procedures were modified during the study period resulting in the termination of obligatory CVC instrumentation for supratentorial procedures. Peri-operative adverse events (AEs) were evaluated as primary endpoint.

Results

The data of 621 patients in total was analysed in this study (301 with and 320 without CVC). Patient characteristics and surgical procedures were comparable between both study groups. A total of 132 peri-operative AEs (81 in the group with CVC vs. 51 in the group without CVC) regarding neurological, neurosurgical, cardiovascular events and death were observed. CVC patients suffer from AEs almost twice as often as non CVC patients (OR_adjusted = 1.98; 95%CI[1.28–3.06]; p = 0.002). Complications related to catheter placement (pneumothorax and arterial malpuncture) were observed in 1.0% of the cases. The ICU treatment period in patients with CVC was 22 (19;24) vs. 21 (19;24) hours (p = 0.413). The duration of hospital stay was also similar between groups (9 (7;13) vs. 8 (7;11) days, p = 0.210). The total time of ventilation (350 (300;440) vs. 335 (281;405) min, p = 0.003) and induction time (40 (35;50) vs. 30 (25;35) min, p<0.001) was found to be prolonged significantly in the group with CVCs. There were no differences found in post-operative inflammatory markers as well as antibiotic treatment.

Conclusion

The data of our retrospective study suggests that patients undergoing elective neurosurgical procedures with CVCs do not demonstrate any additional benefits in comparison to patients without a CVC.