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1. The Agency for Healthcare Research and Quality (AHRQ) reports that, “unsuccessful insertion of central venous catheters (CVCs) may occur in up to 20% of cases,” and that, “in general, the rate of major CVC complications (e.g., pneumothorax or vessel laceration requiring repair) and minor complications (e.g., arterial puncture without significant hemorrhage, transient catheter malposition) is between 0.5 and 10%.”
United States. 2001. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence report/technology assessment, no. 43. Rockville, Md: Agency for Healthcare Research and Quality. http://www.ahrq.gov/clinic/ptsafety/chap21.htm
Primary data sources:
- Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994;331:1735-1738. http://content.nejm.org/cgi/content/full/331/26/1735
- Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986;146:259-261. http://archinte.ama-assn.org/cgi/content/abstract/146/2/259
- Bernard RW, Stahl WM. Subclavian vein catheterizations: a prospective study. I. Non-infectious complications. Ann Surg 1971;173:184-190. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1397638/pdf/annsurg00397-0016.pdf
2. Iatrogenic Pneumothorax (ICD-9 512.1) was reported in 29,691 of 12,866,082 total Medicare discharges in 2007. Infection due to central venous catheter (ICD-9 999.31) was reported in 24,420 of 11,855,943 total Medicare discharges in 2008.
MedPAR data from the Centers for Medicare and Medicaid Services (CMS), analyzed by KNG Consulting.
3. “The method used [to perform taps] was associated with significant differences in occurrence of pneumothorax, favoring sonography. Pneumothorax developed more frequently in patients with either small or large effusions when taps were performed with the clinical, rather than the sonography-guided method (18% vs 3% for small, p = .0001; and 14% vs 2% for large effusions, p = .012).”
Raptopoulos V, LM Davis, G Lee, C Umali, R Lew, and RS Irwin. 1991. "Factors affecting the development of pneumothorax associated with thoracentesis". AJR. American Journal of Roentgenology. 156 (5): 917-20. http://www.ajronline.org/cgi/reprint/156/5/917.pdf
4. The median rate of catheter-related bloodstream infections in the ICU is 5.3 per 1,000.
"National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from October 1986-April 1998, Issued June 1998". 1998. American Journal of Infection Control. 26 (5): 522-533. http://download.journals.elsevierhealth.com/pdfs/journals/0196-6553/PIIS0196655398700264.pdf
5. “A total of 250,000 cases of CVC-associated BSIs have been estimated to occur annually if entire hospitals are assessed rather than ICUs exclusively. In this case, attributable mortality is an estimated 12%-25% for each infection, and the marginal cost to the health-care system is $25,000 per episode.”
O'Grady NP, M Alexander, EP Dellinger, JL Gerberding, SO Heard, DG Maki, H Masur, et al. 2002. "Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention". MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control. 51 (RR-10). http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm
Primary data source:
- Kluger DM, Maki DG. The relative risk of intravascular device related bloodstream infections in adults [Abstract]. In: Abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Francisco, CA: American Society for Microbiology, 1999:514.
6. “Depending on age and comorbidities, iatrogenic pneumothorax was associated with 4 to 7 excess days in length of stay, between $17,000 and $45,000 in excess charges, and 1% to 14% in excess mortality.”
Zhan C, M Smith, and D Stryer. Incidences, Outcomes and Factors Associated with Iatrogenic Pneumothorax in Hospitalized Patients [abstract]. In: AcademyHealth Annual Research Meeting.; 2004; San Diego, Calif. AcademyHealth. 2004; 21: abstract no. 1862. http://www.academyhealth.org/files/2004/abstracts/quality.pdf
7. For information on CMS’ program on hospital acquired conditions, please see: http://www.cms.hhs.gov/hospitalacqcond
8. For information on CMS’ quality reporting/value based purchasing program, please see: http://www.cms.hhs.gov/QualityInitiativesGenInfo/01_overview.asp
9. Injuries and Liability Related to Central Vascular Catheters–A Closed Claims Analysis”, Domino et al. Anesthesiology 2004; 100:1411-8. http://journals.lww.com/anesthesiology/Fulltext/2004/06000/Injuries_and_Liability_Related_to_Central_Vascular.13.aspx
10. “Real-time [ultrasound guidance] for CVC insertion is associated with a significant reduction in placement failures as compared with the usual landmark techniques (relative risk 0.32, 95% Cl: 0.18-0.55). In addition, this review estimated that [ultrasound] guidance results in decreased complications during attempted CVC placements (relative risk 0.22, 95% Cl: 0.10-0.45), corresponding to a relative risk reduction of 78%.”
United States. 2001. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence report/technology assessment, no. 43. Rockville, Md: Agency for Healthcare Research and Quality. http://www.ahrq.gov/clinic/ptsafety/chap21.htm
Primary data source:
11. “The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice.” Increased overall success rate (100% versus 94%), reduction in the frequency of carotid puncture (1% versus 11%), reduction in carotid haematoma (0.4% versus 8.4%), reduction in haemothorax (0% versus 1.7%), decreased pneumothorax (0% versus 2.4%) and reduction in central venous catheter associated bloodstream infection (10% versus 16%).”
Karakitsos D, N Labropoulos, De Groot E, AP Patrianakos, G Kouraklis, J Poularas, G Samonis, DA Tsoutsos, MM Konstadoulakis, and A Karabinis. 2006. "Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients". Critical Care (London, England). 10 (6): R162. http://ccforum.com/content/10/6/R162
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