Abstract
To reduce mechanical complications of central venous catheterization (CVC), we initiated a five-strategy program at Kyorin University Hospital : 1) standardization of the informed consent ; 2) establishment of certification for CVC insertion ; 3) obligation to submit an observation record with every CVC insertion ; 4) revision of the manual for CVC insertion methods ; and 5) implementation of continuing education courses for safety management of CVC. A practical skill tests was required of junior residents. The outcome (four years after starting the 5 point program) showed overall mechanical complications occurred in 3.12% of insertion cases in our hospital. With regards to catheter related blood stream infection, we strongly recommended 0.5% chlorhexidine alcohol solution as a skin disinfectant of the CVC site, expecting an immediate effect and durable protection according to the CDC 2011 guidelines. We also considered the availability of these products in Japan. Following on the achievements of Dr. Pronovost, we strive to employ effective measures to prevent CVC insertion complications under strong leadership. We must build a culture that attaches great importance to safety management in invasive medical care.
