Variation in Arterial and Central Venous Catheter Use in Pediatric Intensive Care Units

Malini Mahendra; Patrick McQuillen; R Adams Dudley; Martina A Steurer

doi:10.1177/0885066620962450

Variation in Arterial and Central Venous Catheter Use in Pediatric Intensive Care Units

J Intensive Care Med. 2021 Nov;36(11):1250-1257. doi: 10.1177/0885066620962450. Epub 2020 Sep 24.

Authors

Malini Mahendra^{1

2}, Patrick McQuillen¹, R Adams Dudley^{3

4}, Martina A Steurer¹

Affiliations

¹ Division of Pediatric Critical Care, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA.
² Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
³ Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota, MN, USA.
⁴ Center for Care Delivery and Outcomes Research, Minneapolis VAMC, MN, USA.

PMID: 32969326
DOI: 10.1177/0885066620962450

Abstract

Objective: Describe patient and hospital characteristics associated with Arterial Catheter (AC) or Central Venous Catheter (CVC) use among pediatric intensive care units (ICUs).

Design: Hierarchical mixed effects analyses were used to identify patient and hospital characteristics associated with AC or CVC placement. The ICU adjusted median odds ratios (ICU-AMOR) for the admission ICU, marginal R², and conditional intraclass correlation coefficient were reported.

Setting: 166 PICUs in the Virtual PICU Systems (VPS, LLC) Database.

Patients: 682,791 patients with unscheduled admissions to the PICU.

Intervention: None.

Measures and main results: ACs were placed in (median, [interquartile range]) 8.2% [4.9%-11.3%] of admissions, and CVCs were placed in 14.9% [10.4%-19.3%] of admissions across cohort ICUs. Measured patient characteristics explained about 25% of the variability in AC and CVC placement. Higher Pediatric Index of Mortality 2 (PIM2) illness severity scores were associated with increased odds of placement (Odds Ratio (95th% Confidence Interval)) AC: 1.88 (1.87-1.89) and CVC: 1.82 (1.81-1.83) per 1 unit increase in PIM2 score. Primary diagnoses of cardiovascular, gastrointestinal, hematology/oncology, infectious, renal/genitourinary, rheumatology, and transplant were associated with increased odds of AC or CVC placement compared to a primary respiratory diagnosis. Presence of in-house attendings 24/7 was associated with increased odds of AC placement 1.32 (1.11-1.57). Admission ICU explained 4.9% and 3.5% of the variability in AC or CVC placement, respectively. The ICU-AMOR showed a patient would have a median increase in odds of 55% and 43% for AC or CVC placement, respectively, if the same patient moved from an ICU with lower odds of placement to an ICU with higher odds of placement.

Conclusions: Variation in AC or CVC use exists among PICUs. The admission ICU was more strongly associated with AC than with CVC placement. Further study is needed to understand unexplained variation in AC and CVC use.

Keywords: central venous catheter; clinical research; epidemiology; hemodynamic monitoring; pediatric intensive care; resource utilization.

MeSH terms

Catheterization, Central Venous*
Catheterization, Peripheral*
Central Venous Catheters*
Child
Cohort Studies
Humans
Intensive Care Units
Intensive Care Units, Pediatric