Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis

Pavel Napalkov, Diana M Felici, Laura K Chu, Joan R Jacobs, Susan M Begelman, Pavel Napalkov, Diana M Felici, Laura K Chu, Joan R Jacobs, Susan M Begelman

Abstract

Background: Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement.

Methods: Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association's Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter-related complications (MCRCs).

Results: Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter-related complications were most frequently seen in patients 16 years or younger.

Conclusions: The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters. Data provided in this study can be applied toward improving patient care.

Figures

Figure 1
Figure 1
Patient assignment into CVC and HD cohorts. CPT, Current Procedural Terminology; CVC, central venous catheter; HD, hemodialysis. *With the exception of CPT code 36800 “Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein” that does not require an accompanying renal dialysis or renal failure claim.
Figure 2
Figure 2
Incidence of any catheter-related complication by baseline cancer status and duration of catheter placement. Vertical bars indicate 95% confidence intervals (CIs). CVC, central venous catheter; HD, hemodialysis.
Figure 3
Figure 3
Incidence of any catheter-related complication during the first 90 days of catheter placement. Results are presented by patient cohort, patient age, and baseline cancer status. There were no children <2 years old in the HD cohort. Vertical bars indicate 95% confidence intervals (CIs). CVC, central venous catheter; HD, hemodialysis.
Figure 4
Figure 4
Yearly incidence of CRBSI and thrombosis in patients with CVCs (A) or HD catheters (B). Data for 2001 to 2006 are shown. Vertical bars indicate 95% confidence intervals (CIs). CRBSI, catheter-related bloodstream infection; CVC, central venous catheter; HD, hemodialysis.

References

    1. Akoh JA. Vascular access infections: epidemiology, diagnosis, and management. Curr Infect Dis Rep. 2011;13:324–332. doi: 10.1007/s11908-011-0192-x.
    1. Lorente L, Henry C, Martín MM, Jiménez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care. 2005;13:R631–R635. doi: 10.1186/cc3824.
    1. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Healthcare Infection Control Practices Advisory Committee (HICPAC) Clinical Infectious Diseases. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;13:1087–1099. doi: 10.1093/cid/cir138.
    1. Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, Canaud BJ, Pisoni RL. Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant. 2008;13:3219–3226. doi: 10.1093/ndt/gfn261.
    1. Vazquez MA. Vascular access for dialysis: recent lessons and new insights. Curr Opin Nephrol Hypertens. 2009;13:116–121. doi: 10.1097/MNH.0b013e328325d635.
    1. Lok CE. Fistula first initiative: advantages and pitfalls. Clin J Am Soc Nephrol. 2007;13:1043–1053. doi: 10.2215/CJN.01080307.
    1. Chan MR. Hemodialysis central venous catheter dysfunction. Semin Dial. 2008;13:516–521. doi: 10.1111/j.1525-139X.2008.00495.x.
    1. Nakazawa N. Infectious and thrombotic complications of central venous catheters. Semin Oncol Nurs. 2010;13:121–131. doi: 10.1016/j.soncn.2010.02.007.
    1. Boersma RS, Jie KS, Verbon A, van Pampus EC, Schouten HC. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Ann Oncol. 2008;13:433–442.
    1. US Renal Data System. USRDS 2006 annual data report: atlas of end-stage renal disease in the United States (Appendix A, p. 248–249; p. 261, Tables A and B) Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2006. .
    1. US Renal Data System. USRDS 2007 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States (Appendix A, pp. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Bethesda, MD; 2007. .
    1. US Renal Data System. USRDS 2008 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States (Appendix A, pp. 211 and 223, Tables 11a.b and 11a.c) Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2008. .
    1. Levy I, Bendet M, Samra Z, Shalit I, Katz J. Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J. 2010;13:426–429. doi: 10.1097/INF.0b013e3181c94d9e.
    1. Pinon M, Bezzio S, Tovo PA, Fagioli F, Farinasso L, Calabrese R, Marengo M, Giacchino M. A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr. 2009;13:1505–1512. doi: 10.1007/s00431-009-0968-2.
    1. Hammarskjold F, Wallen G, Malmvall BE. Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors. Acta Anaesthesiol Scand. 2006;13:451–460. doi: 10.1111/j.1399-6576.2006.00974.x.
    1. Matsuzaki A, Suminoe A, Koga Y, Hatano M, Hattori S, Hara. Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children. Support Care Cancer. 2006;13:153–160. doi: 10.1007/s00520-005-0848-x.
    1. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;13:1123–1133. doi: 10.1056/NEJMra011883.
    1. Merrer J, De Jonghe B, Golliot F, Lefrant J-Y, Raffy B, Barre E, Rigaud J-P, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G. for the French Catheter Study Group in Intensive Care. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized trial. JAMA. 2001;13:700–707. doi: 10.1001/jama.286.6.700.
    1. Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, Forel J-M, Marqué S, Misset B, Airapetian N, Daurel C, Mira J-P, Ramakers M, du Cheyron D, Le Coutour X, Daubin C, Charbonneau P. for Members of the Cathedia Study Group. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA. 2008;13:2413–2422. doi: 10.1001/jama.299.20.2413.
    1. Hadaway LC. Reopen the pipeline for IV therapy. Nursing. 2005;13:54–60.
    1. Lee AY, Levine MN, Butler G, Webb C, Costantini L, Gu C, Julian JA. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol. 2006;13:1404–1408. doi: 10.1200/JCO.2005.03.5600.
    1. Hryszko T, Brzosko S, Mazerska M, Malyszko J, Mysliwiec M. Risk factors of nontunneled noncuffed hemodialysis catheter malfunction. A prospective study. Nephron Clin Pract. 2004;13:c43–c47. doi: 10.1159/000076398.
    1. Sharma A, Zilleruelo G, Abitbol C, Montane B, Strauss J. Survival and complications of cuffed catheters in children on chronic hemodialysis. Pediatr Nephrol. 1999;13:245–248. doi: 10.1007/s004670050602.
    1. Cortelezzi A, Moia M, Falanga A, Pogliani EM, Agnelli G, Bonizzoni E, Gussoni G, Barbui T, Mannucci PM. CATHEM Study Group. Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol. 2005;13:811–817. doi: 10.1111/j.1365-2141.2005.05529.x.
    1. Johnson EM, Saltzman DA, Suh G, Dahms RA, Leonard AS. Complications and risks of central venous catheter placement in children. Surgery. 1998;13:911–916. doi: 10.1016/S0039-6060(98)70016-9.
    1. Di Iorio B, Lopez T, Procida M, Marino P, Valente V, Iannuzziello F, Bombini A, Bellizzi V, Terracciano V, Bagnato C, Casino F, Gaudiano V, Mostacci D, Santarsia G, Biscione R, Caputo A, Ferlan G, Lauria MA, Marinaro G, Molinari R, Sanicandro D, Lotito MA, Plastino G, Carretta P. Successful use of central venous catheter as permanent hemodialysis access: 84-month follow-up in Lucania. Blood Purif. 2001;13:39–43. doi: 10.1159/000014477.
    1. US Census Bureau, Population Division. Table 1: Annual Estimates of the Population for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1, 2007 (NST-EST2007-01) 2012. .
    1. World Health Organization. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Geneva, Switzerland: World Health Organization; 2008.
    1. Preskitt JT, Bothe A Jr, Harris JA. CPT changes in 2004. Bull Am Coll Surg. 2004;13:21–24.
    1. American Medical Association Physician Consortium for Performance Improvement. Prevention of catheter-related bloodstream infections (CRBSI) – central venous catheter insertion protocol (Physician performance measures and related data specifications) Chicago, IL: American Medical Association; 2007.
    1. de Jonge RC, Polderman KH, Gemke RJ. Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med. 2005;13:329–339. doi: 10.1097/01.PCC.0000161074.94315.0A.
    1. Oguzkurt L, Tercan F, Torun D, Yildirim T, Zumrutdal A, Kizilkilic O. Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study. Eur J Radiol. 2004;13:293–299. doi: 10.1016/j.ejrad.2003.12.004.
    1. Power A, Singh S, Ashby D, Hamady M, Moser S, Gedroyc W, Taube D, Duncan N, Cairns T. Translumbar central venous catheters for long-term haemodialysis. Nephrol Dial Transplant. 2010;13:1588–1595. doi: 10.1093/ndt/gfp683.
    1. Zingg W, Cartier-Fassler V, Walder B. Central venous catheter-associated infections. Best Pract Res Clin Anaesthesiol. 2008;13:407–421.
    1. Baskin JL, Pui CH, Wilimas JA, Metzger ML, Ribeiro RC, Howard SC. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet. 2009;13:159–169. doi: 10.1016/S0140-6736(09)60220-8.
    1. Lordick F, Hentrich M, Decker T, Hennig M, Pohlmann H, Hartenstein R, Peschel C. Ultrasound screening for internal jugular vein thrombosis aids the detection of central venous catheter-related infections in patients with haemato-oncological diseases: a prospective observational study. Br J Haematol. 2003;13:1073–1078. doi: 10.1046/j.1365-2141.2003.04199.x.
    1. Yacopetti N. Central venous catheter-related thrombosis: a systematic review. J Infus Nurs. 2008;13:241–248. doi: 10.1097/01.NAN.0000326833.59655.9e.
    1. Abdelkefi A, Ben Romdhane N, Krias A, Chelli M, Torjman L, Ladeb S, Ben Othman T, Lakhal A, Guermazi S, Ben Hassen A, Ladeb F, Ben Abdeladhim A. Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplant recipients. Bone Marrow Transplant. 2005;13:885–889. doi: 10.1038/sj.bmt.1705156.
    1. Van Rooden CJ, Rosendaal FR, Meinders AE, Van Oostayen JA, Van Der Meer FJ, Huisman MV. The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis. Haematologica. 2004;13:201–206.
    1. Tesselaar ME, Ouwerkerk J, Nooy MA, Rosendaal FR, Osanto S. Risk factors for catheter-related thrombosis in cancer patients. Eur J Cancer. 2004;13:2253–2259. doi: 10.1016/j.ejca.2004.06.023.
    1. Boersma RS, Hamulyak K, Cate HT, Schouten HC. Congenital thrombophilia and central venous catheter-related thrombosis in patients with cancer. Clin Appl Thromb Hemost. 2010;13:643–649.
    1. Goetz AM, Wagener MM, Miller JM, Mudder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol. 1998;13:842–845. doi: 10.1086/647742.
    1. Parienti JJ, du Cheyron D, Timsit JF, Traoré O, Kalfon P, Mimoz O, Mermel LA. Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults. Crit Care Med. 2012;13:1627–1634. doi: 10.1097/CCM.0b013e31823e99cb.

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