Injuries and liability related to central vascular catheters: a closed claims analysis.

Abstract:

BACKGROUND:To assess changing patterns of injury and liability associated with central venous or pulmonary artery catheters, the authors analyzed closed malpractice claims for central catheter injuries in the American Society of Anesthesiologists Closed Claims database. METHODS:All claims for which a central catheter (i.e., central venous or pulmonary artery catheter) was the primary damaging event for the injury were compared with the rest of the claims in the database. Central catheter complications were defined as being related to vascular access or catheter use or maintenance. Statistical analysis was performed using the chi-square test, Fisher exact test, or Z test (proportions) and the Kolmogorov-Smirnov test (payments). RESULTS:The database included 110 claims for injuries related to central catheters (1.7% of 6,449 claims). Claims for central catheter injuries had a higher severity of injury, with an increased proportion of death (47%) compared with other claims in the database (29%, P < 0.01). The most common complications were wire/catheter embolus (n = 20), cardiac tamponade (n = 16), carotid artery puncture/cannulation (n =16), hemothorax (n =15), and pneumothorax (n =14). Cardiac tamponade, hemothorax, and pulmonary artery rupture had a higher proportion of death (P < 0.05) compared with the rest of the central catheter injures. The proportion of claims for vascular access injury increased (47% to 84%) and use/maintenance injury decreased (53% to 16%) in 1994-1999 compared with 1978-1983 (P < 0.05). CONCLUSIONS:Claims related to central catheters had a high severity of patient injury. The most common complications causing injury were wire/catheter embolus, cardiac tamponade, carotid artery puncture/cannulation, hemothorax, and pneumothorax.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Domino KB,Bowdle TA,Posner KL,Spitellie PH,Lee LA,Cheney FW

doi

10.1097/00000542-200406000-00013

subject

Has Abstract

pub_date

2004-06-01 00:00:00

pages

1411-8

issue

6

eissn

0003-3022

issn

1528-1175

pii

00000542-200406000-00013

journal_volume

100

pub_type

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