title: Cost and safety of pediatric intensive care physician-placed broviac catheters.
abstract: OBJECTIVE
  To compare the cost and safety of placement of Broviac catheters in children by pediatric intensivists in a sedation suite versus placement by pediatric surgeons in the operating room.
  
  
  METHODS
  Single-center retrospective analysis.
  
  
  METHODS
  Pediatric sedation suite and operating rooms in a tertiary care children's hospital.
  
  
  METHODS
  All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  We reviewed the charts of all pediatric patients with Broviac catheters placed, either by intensivists or surgeons, and compared cost and outcomes. Procedure safety was assessed and categorized into immediate, short-term (within 2 wk of procedure), and long-term outcomes. Anesthetic safety and billing data for the procedure were also collected. Among similar patient populations, immediate complications, such as pneumothorax, procedure failure (p > 0.999), and anesthetic complications (p = 0.60), were not significantly different. Short-term outcomes, including infection (p = 0.27) and catheter malfunction (p > 0.999), were not different. Long-term outcomes, including mean indwelling catheter days (p = 0.60) and removal due to catheter infection (p = 0.09), were not different between the groups. Overall cost of the procedure was significantly different: $7,031 (± $784) when performed by surgeons and $3,565 (± $311) when performed by intensivists (p < 0.001).
  
  
  CONCLUSIONS
  Pediatric critical care physicians can place Broviac catheters as safely as pediatric surgeons and at a lower cost in a defined patient population.
authors.affiliation: 1Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, Grand Rapids, MI. 2Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, MI. 3Department of Pediatric Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Fitzgerald
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Yu
authors.forename: Surender
authors.initials: S
authors.lastname: Rajasekaran
authors.forename: Scott E
authors.initials: SE
authors.lastname: Curtis
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Robertson
authors.forename: Jenifer M
authors.initials: JM
authors.lastname: Wincek
authors.forename: Rachel
authors.initials: R
authors.lastname: Blanton
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Sanfilippo
mesh_terms: D000758:Anesthesia / Q000009:adverse effects / Q000191:economics; D055499:Catheter-Related Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002675:Child, Preschool; D003422:Critical Care / Q000191:economics*; D004868:Equipment Failure; D006801:Humans; D007223:Infant; D009873:Operating Rooms; D061646:Operative Time; D010372:Pediatrics / Q000191:economics*; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000191:economics*