Retrospective Analysis of Complications in Central Venous Catheter Insertions: A Single Centre Experience in India

Objectives: This study aimed to analyze the incidence, types, and risk factors associated with central venous catheter (CVC) insertion complications in a tertiary care center in India. It sought to evaluate the impact of insertion techniques (ultrasound-guided vs. landmark) and anatomical sites on complication rates, while addressing barriers to ultrasound adoption in the Indian healthcare context. Methodology: A retrospective cohort study was conducted at a single center in Punjab, analyzing 1264 CVC insertions performed between July 2021 and December 2023. Data were extracted from electronic and paper medical records, including patient demographics, insertion site (subclavian, internal jugular [IJV], and femoral), technique (ultrasound-guided or landmark), catheter type, and complications (early: Arterial puncture, pneumothorax; delayed: Infection, thrombosis). Statistical analyses included descriptive statistics, Chi-square tests, and ANOVA to compare outcomes. Results: The overall complication rate was 8.15% (early: 5.62%, delayed: 2.53%). Subclavian insertions were most common (71.7%), followed by femoral (16.2%) and IJV (12.1%). Ultrasound guidance was used in only 9.3% of cases but demonstrated zero early complications in subclavian insertions ( P = 0.01). Femoral catheters had the highest thrombosis rate (2.9%) and shortest dwell time (median 3 days). Infection rates (1.36 per 1000 catheter days) showed no correlation with dwell time ( P = 0.612). The landmark technique predominated (90.7%), with low pneumothorax rates (0.2%) despite high subclavian use. Conclusion: This study highlights the safety benefits of ultrasound guidance, particularly for subclavian CVCs, and underscores the need for policy reforms to overcome barriers to its adoption in India. Femoral catheters, despite shorter dwell times, posed higher thrombosis risks, suggesting careful site selection is critical. Standardized protocols and targeted training could further reduce complications in resource-limited settings.