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Tip location and Catheter malfunction

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Bansal et al (2008) highlight the impact of suboptimal central venous access device tip placement on the incidence of early catheter malfunction.

Bansal, A., Binkert, C.A., Robinson, M.K., Shulman, L.N., Pellerin, L. and Davison, B. (2008) Impact of Quality Management Monitoring and Intervention on Central Venous Catheter Dysfunction in the Outpatient Chemotherapy Infusion Setting. Journal of Vascular and Interventional Radiology. 19(8), p.1171-1175.


Purpose: 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.

Materials and 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.