title: Inappropriate intravascular device use: a prospective study.
abstract: Despite the clinical significance of complications due to intravascular catheters, the inappropriate use of intravascular catheters in hospitalised patients has not been adequately characterised. The objective of this prospective observational study was to develop definitions for appropriate intravascular device use, to estimate the frequency of inappropriate use of intravascular devices, and to examine risk factors and outcomes associated with inappropriate use in hospitalised patients. Among 436 patients admitted between October and December 2007, a total of 2909 hospitalisation days and use of 876 intravascular devices was observed. Of the 3806 total catheter-days recorded, 1179 (31%) were found to be inappropriate based on the study criteria. Logistic regression analysis indicated that age, total number of catheters used and total duration of catheterisation were risk factors for inappropriate device use (P<0.05). Inappropriate usage was strongly associated with increased intensive care unit admission (P<0.05) and length of hospital stay (4.9±4.3 days for appropriate vs 8.5±12.6 days for inappropriate; P<0.05). Use of central venous catheters was not a predictor for inappropriate device use. Inappropriate intravascular device use is a very common phenomenon in hospitalised patients and is strongly linked to adverse device-related outcomes. These results may be used to develop strategies to systematically reduce excessive intravascular device use which would be expected to reduce adverse events associated with morbidity, mortality, and excess healthcare costs.
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Tiwari
authors.forename: E D
authors.initials: ED
authors.lastname: Hermsen
authors.forename: M E
authors.initials: ME
authors.lastname: Charlton
authors.forename: J R
authors.initials: JR
authors.lastname: Anderson
authors.forename: M E
authors.initials: ME
authors.lastname: Rupp
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors