title: Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis.
abstract: BACKGROUND
  Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement.
  
  
  METHODS
  Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association's Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter-related complications (MCRCs).
  
  
  RESULTS
  Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter-related complications were most frequently seen in patients 16 years or younger.
  
  
  CONCLUSIONS
  The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters. Data provided in this study can be applied toward improving patient care.
authors.affiliation: Genentech, Inc,, 1 DNA Way, South San Francisco, CA 94080, USA. napalkov.pavel@gene.com.
authors.forename: Pavel
authors.initials: P
authors.lastname: Napalkov
authors.forename: Diana M
authors.initials: DM
authors.lastname: Felici
authors.forename: Laura K
authors.initials: LK
authors.lastname: Chu
authors.forename: Joan R
authors.initials: JR
authors.lastname: Jacobs
authors.forename: Susan M
authors.initials: SM
authors.lastname: Begelman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult