Pneumothorax after insertion of central venous catheters in the intensive care unit: association with month of year and week of month
- 1Program in Critical Care Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- 2Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- 3Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
- 4Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- 5Respiratory Division, Vancouver General Hospital, Vancouver, British Columbia, Canada
- 6Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence to: Dr P Dodek Center for Health Evaluation and Outcome Sciences, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6;
- Accepted 11 March 2007
Rationale: One of the complications associated with insertion of central venous catheters (CVCs) is pneumothorax (PTX). Because of housestaff inexperience, it was hypothesised that rates of PTX after insertion of CVCs in teaching hospitals would be highest in July and August and in the first week of the month (beginning of intensive care unit (ICU) rotation).
Methods: In a retrospective analysis of data from patients admitted to the ICU in two tertiary care teaching hospitals in British Columbia from 1999 to 2005, rates of PTX occurring after insertion of CVCs were calculated, and it was evaluated whether rates were increased during certain times of the year/month.
Results: During this period, 3548 patients were admitted to these ICUs and had at least one CVC placed. 5816 CVCs were inserted; 113 PTX occurred within 2 days after insertions (1.9% per CVC). The rate during the last week of the month was greater (2.7%) than during the first, second or third weeks (1.7%, 1.8% and 1.4%, respectively). This effect persisted after controlling for the Acute Physiology and Chronic Health Evaluation II score, the number of catheters placed per patient, gender, age and hospital. Rates of PTX after catheter placement did not vary by the month of the year.
Conclusions: The rate of PTX after insertion of CVCs is greatest in the last week of the month. If this effect can be verified in other centres, increased supervision of residents at the end of ICU rotations when placing CVCs should be considered. Whether this effect applies to other patient safety outcomes in the ICU also needs further study.
- APACHE, Acute Physiology and Chronic Health Evaluation
- CVC, central venous catheter
- ICU, intensive care unit
- PTX, pneumothorax
Funding: This work was supported by the BC Health Research Foundation, the Keenan Foundation and the Michael Smith Foundation for Health Research (Infrastructure Grant—ICU Patient Safety Team). NTA was supported by a Michael Smith Foundation Health Research Scholar Award, a Departmental Scholar Award from the Department of Medicine UBC and a CIHR/BC Lung Association New Investigator Award.
Competing interests: None.