Injuries and liability related to central vascular catheters: a closed claims analysis.
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.
Domino
Karen B
KB
Department of Anesthesiology, University of Washington, Seattle, 98195-6540, USA. kdomino@u.washington.edu
Bowdle
T Andrew
TA
Posner
Karen L
KL
Spitellie
Pete H
PH
Lee
Lorri A
LA
Cheney
Frederick W
FW
D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data* / Q000639:trends; D016009:Chi-Square Distribution; D016208:Databases, Factual / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data* / Q000639:trends; D007431:Intraoperative Complications / Q000453:epidemiology*; D008318:Malpractice / Q000706:statistics & numerical data* / Q000639:trends; D018709:Statistics, Nonparametric