How often do complications occur?
- The Agency for Healthcare Research & Quality (AHRQ) reports that unsuccessful insertion of central venous catheters (CVCs) occur in up to 20% of all cases. (1)
- The rate of major and minor CVC complications is up to 10%. (1)
- Iatrogenic Pneumothorax (IP)
- MedPAR data from the Centers for Medicare and Medicaid Services (CMS) indicates that IP was reported in 2.31 per 1,000 discharges in 2007. (2)
- As many as 18% of thoracenteses are complicated by pneumothorax. (3)
- Catheter-Related Blood Stream Infections (BSI)
- MedPAR data from CMS indicates infection due to central venous catheter was reported in 2.06 per 1,000 discharges in 2008. (2)
- The Centers for Disease Control (CDC) further estimates the rate of BSI is 5.3 per 1,000 catheter days in Intensive Care Units (3) and that 250,000 such infections occur annually. (5)
What is the cost of complications?
| Complication/Infection |
Source of Data |
Attributable Cost Per Incident |
| Catheter-related Blood Stream Infection |
Infection Centers for Disease Control |
$25,000 (5) |
| Iatrogenic Pneumothorax |
Zhan, et al, AHRQ |
$17,000–$45,000 (6) |
- AHRQ reports iatrogenic pneumothorax is associated with an increased length of hospital stay of 4-7 days. (6)
- Under Medicare’s Hospital-Acquired Condition (HAC) and Present on Admission (POA) Indicator Reporting policy, hospital-acquired blood stream infections reduce reimbursement for discharges by an average of 33% (in the absence of any other qualifying condition). (7)
- Under Medicare’s Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program, facilities much report rates of iatrogenic pneumothorax to receive the full market basket update: these data will be public beginning in 2010.
- By 2012, it is proposed that hospitals will be required to meet a benchmark in this area to receive the full market basket update. (8)
What is the cost of medical malpractice associated with complications?
An analysis of claims related to injury resulting from central vascular catheter placement (part of the American Society of Anesthesiology Close Claims Project) reveals that “claims related to central catheters had a high severity of patient injury” and resulted in the following payments (9):
(Data in 1999 dollars; claims against anesthesiologists since 1970.)
| Type of Complication |
Median Payment |
Range of Payment |
| Wire/Catheter embolus |
$39,725 |
$654–$132,500 |
| Cardiac tamponade |
$160,245 |
$34,449–$6,912,000 |
| Carotid artery puncture/cannulation |
$40,870 |
$12,975–$527,000 |
| Hemothorax |
$297,000 |
$17,850–$1,435,293 |
| Pneumothorax |
$143,250 |
$1,280–$208,750 |
| Miscellaneous vessel injury |
$184,625 |
$1,000–$1,717,775 |
| All central catheter claims |
$105,500 |
$654–$6,912,000 |
Ultrasound guidance reduces these risks.
Based upon overwhelming supportive clinical evidence, the AHRQ recommends ultrasound guidance be used for all central venous cannulation.
- Ultrasound guidance for CVC significantly reduces placement failures and reduces complications during attempted CVC placements with a relative risk reduction of 78%. (10)
- Ultrasound guidance reduces the rate of pneumothorax resulting from thoracentesis to 3% or lower (vs. 18% without ultrasound). (3)
- In a study of 900 critical care patients, ultrasound guidance of internal jugular vein catheterization reduced complications dramatically as seen below (11):
| Complication/Infection |
Landmark-Based Technique |
Ultrasound Guided |
| Carotid Puncture |
11% |
1% |
| Carotid Hematoma |
8.4% |
0.4% |
| Pneumothorax |
2.4% |
0% |
| Catheter-Related Infection |
16% |
10% |
