Assessing Pain Level, Patient Satisfaction, and Frequency of Injury to Adjacent Anatomical Structures During Central Venous Catheter Placement Under Local Anesthesia




Background: Central venous catheters (CVCs) are increasingly used for central vein pressure measurement, fluid replacement, blood-product transfusion, hemodialysis, and chemotherapy. Considering the urgent nature of placing CVCs in many patients, local anesthesia is used in order to facilitate recovery and prevent the side effects of general anesthesia. The successful placement of CVCs can reduce injury to adjacent structures. Objectives: This study aimed to assess the patients’ pain level, satisfaction, and injury to adjacent structures. Patients and Methods: This case series evaluated 213 patients with end-stage renal disease (ESRD) who had been referred for duallumen hemodialysis catheter (large-bore) placement during the year 2011 at Hasheminejad kidney center (Tehran, Iran). Catheters were placed by a single surgeon, and 5 ml of subcutaneous lidocaine 2% was used at the site of catheterization. At the end of the procedure, pain was measured using a visual analog scale, and the patients’ satisfaction was verbally determined with regard to whether they would accept local anesthesia if they required catheter placement again in the future. Results: Fifteen patients reported that they would prefer general anesthesia for a similar procedure in the future. Five of these patients experienced mild pain with the present procedure, and the remainder had severe pain. The mean pain scores were 1.93 ± 0.799 in patients who preferred general anesthesia and 1.26 ± 0.450 in the remainder. The difference between the two groups was significant. One hundred ninety-eight patients experiencedmild pain during catheter placement, of which 187 (94.4%) would accept local anesthesia for this procedure in the future. Twenty-two (10.3%) patients underwent arterial puncture, 163 had single-attempt venous puncture, and 50 had two or more puncture attempts. In nine patients, the puncture was unsuccessful and the vein could not be found despite three attempts to insert the needle; for these patients, the anatomical area approached for access was changed. Conclusions: Local anesthesia facilitates quick recovery, is time-saving, and can reduce hospital expenses. It seems to be a suitable method for reducing complications and increasing patient satisfaction.