Does number of years of experience eliminate complications in vascular access?

A total of 498 patients in whom a port, Hickman or central venous catheter was inserted between 2014-2017 in the Operating Room of the Pediatric Surgery Department (Ege University School of Medicine) after obtaining the approval of the Hospital ethics committee (Ethics committee number: 18-9.1 / 32, Date: 18/09/2018) were included in this retrospective study. Patients' age, gender, height, weight, anesthesia method, type and size of the catheter, the catheterized vein, the number of punctures, the time to blood return (time from the beginning of the puncture to the control of blood flow from the catheter with aspiration as expressed in minutes), the short-term mechanical complications emerged during the insertion and follow-up to 24 hours post-operatively. All catheterizations were performed by anesthesiologists (faculty member, anesthesiologist or research assistant) using anatomic landmarks (without the guidance of ultrasonography) and Seldinger method after necessary sterile conditions were provided in the pediatric surgery operating room. The anatomical region selected for the catheter insertion was determined taking into account the diagnosis of the patient, the operation to be performed, or the clinical condition of the patient. Subclavian, femoral, and internal jugular veins were preferred for catheterization. Propofol (2 mg/kg) was administered intravenously to patients with available intravenous access, and premedication with midazolam (0.75 mg/kg orally) was given for patients without intravenous access and patients were taken to the operating theater. Heart rate and rhythm, respiratory rate and oxygen saturation, noninvasive arterial pressure monitoring, end-tidal carbon dioxide monitoring were applied to the patients during the intervention. The catheter insertion site was left uncovered, and the procedure area was covered with a sterile drape. The catheter was inserted using the Seldinger technique and fixed with sutures. The location of the catheter was confirmed by fluoroscopy and anteroposterior chest radiography. The location of the catheter tip between the superior vena cava and the right atrium was accepted as an appropriate location. The pocket was created by the pediatric surgeon in port catheter applications.