Variation of arterial and central venous catheter use in United States intensive care units

Abstract

Background: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists.

Methods: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter.

Results: Our cohort included 334,123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008]; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P < 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9-72.3%]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8-76.2%]; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5-49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9-72.9%], AMOR, 1.69; vasopressors: 71.4% (59.5-85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9-27.3%), AMOR, 1.90).

Conclusions: Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

Trends in Catheter Utilization, 2001–2008. Trends evaluated using logistic regression revealed odds-ratio (OR) 1.01 per year (P < 0.001) for arterial catheter use, OR 1.08 per year (P < 0.001) for central venous catheter use, and OR 0.87 per year (P < 0.001) for pulmonary artery catheter use. ICU = intensive care unit

Figure 2

Catheter use by ICU specialty and location prior to ICU arrival. (A) AC by ICU specialty, (B) AC by location prior to ICU arrival, (C) CVC by ICU speciality, (D) CVC by location prior to ICU arrival. AC = arterial catheter; combined = medical and surgical ICU; CVC = central venous catheter; ER = emergency room; ICU = intensive care unit; MICU = medical ICU; OpRm/PACU = operating room/postanesthesia care unit; SDU/tele = step-down unit/telemetry unit; SICU = surgical ICU.

Figure 3

Variation in catheter use across individual ICUs. (A) arterial catheters, (B) central venous catheters Error bars = 95% confidence interval for each ICUs utilization rate; dotted line = median of all unit rates; solid lines = interquartile range of all unit rates. ICU = intensive care unit; MICU = medical ICU; SICU = surgical ICU.

Appendix 2 - Figure 4

Trends in AC and CVC (2001–2008) stratified by sepsis diagnosis and location prior to ICU arrival. (A) arterial catheters, (B) central venous catheters ER = emergency room; ICU = intensive care unit; OpRm/PACU = operating room/postanesthesia care unit; OR = odds-ratio calculated by logistic regression.

Appendix 4 - Figure 5

Adjusted odds of catheter use by ICU admission year, 2001–2008. (A) AC placed either in-ICU or pre-ICU, (B) AC placed only pre-ICU, (C) CVC placed either in-ICU or pre-ICU (D) CVC placed only pre-ICU AC = arterial catheter; CVC = central venous catheter; ICU = intensive care unit.