Analysis and management of medical and organizational risks related to central venous catheterization in intensive care units
Central venous catheters (CVC) are medical devices used daily in Intensive Care Units (ICU). The rates of thrombotic, mechanical, and infectious complications related to the CVC are not negligible. It is estimated that 15% of the patients with a CVC develop one. The aim of the study conducted in 2 units (medical and surgical ICU of the hospital of Saint Etienne and surgical ICU of the G. Pompidou hospital in Paris) is to identify risks associated with the device and the patient but also to look for risk factors related to the management of the device and to the organization of the medical staff. The methodology combines several types of approach, the both medical, sociological and systemic. We have studied around 350 patients and 600 CVC during one year. The observation of the functioning of these 2 ICU highlights their organizational differences. Those 2 organizational hierarchies tend to generate different types of complications each with a unique pattern of delays, errors and recovery times. This study shows that the change of the organizational structure can modify patient risk.