title: Variation of arterial and central venous catheter use in United States intensive care units.
abstract: BACKGROUND
  Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists.
  
  
  METHODS
  The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter.
  
  
  RESULTS
  Our cohort included 334,123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008]; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P < 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9-72.3%]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8-76.2%]; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5-49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9-72.9%], AMOR, 1.69; vasopressors: 71.4% (59.5-85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9-27.3%), AMOR, 1.90).
  
  
  CONCLUSIONS
  Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.
authors.affiliation: From the Albert Einstein College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, New York, New York. Current position: Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (H.B.G.); Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada (A.G.); Cerner Corporation, Vienna, Virginia (A.K.); Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada (D.C.S.); Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada, and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (G.R.); and Departments of Anesthesiology and Epidemiology, Columbia University, New York, New York (H.W.).
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Gershengorn
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
authors.forename: Andrew
authors.initials: A
authors.lastname: Kramer
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
authors.forename: Gordon
authors.initials: G
authors.lastname: Rubenfeld
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000379:methods / Q000706:statistics & numerical data*; D057785:Catheters / Q000706:statistics & numerical data*; D062905:Central Venous Catheters / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D014481:United States; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents