title: Impact of quality management monitoring and intervention on central venous catheter dysfunction in the outpatient chemotherapy infusion setting.
abstract: OBJECTIVE
  To assess the utility of maintaining and analyzing a quality-management database while investigating a subjectively perceived increase in the incidence of tunneled catheter and port dysfunction in a cohort of oncology outpatients.
  
  
  METHODS
  All 152 patients undergoing lytic therapy (2-4 mg alteplase) of a malfunctioning indwelling central venous catheter (CVC) from January through June 2004 at a single cancer center in the United States were included in a quality-management database. Patients were categorized by time to device failure and the initial method of catheter placement (surgery vs interventional radiology). Data were analyzed after 3 months, and areas of possible improvement were identified and acted upon. Three months of follow-up data were then collected and similarly analyzed.
  
  
  RESULTS
  In a 6-month period, 152 patients treated for catheter malfunction received a total of 276 doses of lytic therapy. A 3-month interim analysis revealed a disproportionately high rate (34%) of early catheter malfunction (ECM; <30 days from placement). Postplacement radiographs demonstrated suboptimal catheter positioning in 67% of these patients, all of whom had surgical catheter placement. There was a 50% absolute decrease in the number of patients presenting with catheter malfunction in the period from April through June (P < .001). Evaluation of postplacement radiographs in these patients demonstrated a 50% decrease in the incidence of suboptimal positioning (P < .05).
  
  
  CONCLUSIONS
  Suboptimal positioning was likely responsible for some, but not all, cases of ECM. Maintenance of a quality-management database is a relatively simple intervention that can have a clear and important impact on the quality and cost of patient care.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anu
authors.initials: A
authors.lastname: Bansal
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Binkert
authors.forename: Malcolm K
authors.initials: MK
authors.lastname: Robinson
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.forename: Linda
authors.initials: L
authors.lastname: Pellerin
authors.forename: Brian
authors.initials: B
authors.lastname: Davison
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001900:Boston / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology*; D011475:Prosthesis Failure; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D015642:Radiology, Interventional / Q000706:statistics & numerical data*
chemical_list: D000970:Antineoplastic Agents