In an attempt to overcome infections associated with central venous catheters, a new antiseptic central venous catheter coated with benzalkonium chloride on the internal and external surfaces has been developed and evaluated in a clinical trial. Patients (235) randomly received either a triple-lumen central venous catheter coated with benzalkonium chloride (117) or a polyurethane non-antiseptic catheter (118). The incidence of microbial colonization of both catheters and retained antiseptic activity of the benzalkonium chloride device following removal were determined. The benzalkonium chloride resulted in a significant reduction of the incidence of microbial colonization on both the internal and external catheter surfaces. The reduction in colonization was detected at both the intradermal (21 benzalkonium chloride catheters vs. 38 controls, P=0.0016) and distal segments of the antiseptic-coated catheters. Following catheter removal retained activity was demonstrated in benzalkonium chloride catheters which had been in place for up to 12 days. No patients developed adverse reactions to the benzalkonium chloride catheters. The findings demonstrate that the benzalkonium chloride catheter significantly reduced the incidence of catheter-associated colonization.

This study compares prospectively the cardiovascular and catecholamine responses to central venous and pulmonary artery catheterization before and after induction of general anaesthesia. Twenty patients for elective coronary artery surgery were randomized into two groups. One group had central venous and pulmonary artery catheterization performed awake using local anaesthesia. The other group had these catheters inserted following induction of general anesthaesia. In all patients heart rate, arterial blood pressure, ST segment analysis and epinephrine and norepinephrine levels were measured prior to central venous cannulation and at 2-min intervals until placement of the lines was achieved. There were no statistically significant changes in any cardiovascular or catecholamine variable with time compared with the base–line measurements. There were no statistically significant differences in plasma catecholamine levels between the awake and the anaesthetized groups.

Invasive peri- and post-operative monitoring is being increasingly utilized, and a corresponding increase of concomitant complications are becoming apparent.

Two cases of complete right vocal fold paralysis are reported as a possible complication of right central venous catheterization. The underlying aetiology of this complication is presumed to be either direct trauma at the time of introduction of the central venous catheter, or by thrombosis and fibrosis around the recurrent laryngeal or vagus nerve. It is suggested that multiple attempts at cannulation and leaving the central line in situ for long periods increases the risk of this complication.

When the integrity of the left recurrent laryngeal nerve or vagus is jeopardized or must be sacrificed during surgery, it is suggested that ipsilateral central lines are inserted to minimize the risk of bilateral vocal fold paralysis.

Cases of vocal fold paralysis secondary to central line insertion should be followed expectantly and surgical intervention only be considered after 12 months review.

Retrospective review of all patients with recurrent laryngeal nerve palsy seen at a comprehensive cancer centre over a 30 month period has revealed three patients with this diagnosis apparently related to massive venous thrombosis. All three patients had an underlying diagnosis of malignancy (two colon, one breast) and an indwelling central venous access device with its tip in the superior vena cava. Direct laryngoscopy was otherwise normal in all patients, and two had normal CT scans of the neck and mediastinum. This third patient had mediastinal adenopathy, but this was unchanged from the previous nine months. Although two patients expired shortly after this presentation, the other patient lived for one year and his palsy resolved with the resolution of his superior vena cava syndrome. Mediastinal inflammation secondary to the thrombophlebitis may be the direct cause of this unusual presentation.