Pediatric Intensive Care Physician-Placed Broviac Catheters
Pediatric Intensive Care Physician-Placed Broviac Catheters
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.
Design: Single-center retrospective analysis.
Setting: Pediatric sedation suite and operating rooms in a tertiary care children's hospital.
Patients: All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009.
Interventions: None.
Measurements and Main 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.
Broviac catheters are widely used in the care of children with malignancies and other chronic illness who require long-term central venous access. These tunneled catheters allow for frequent blood sampling and administration of medication and nutrition in pediatric patients without the discomfort and anxiety of frequent needle sticks. The use and benefits of long-term central venous access devices (CVADs) in children are well established.
Traditionally, Broviac catheters have been placed in patients under general anesthesia by pediatric surgeons in the operating room (OR). This study examines an alternative approach—the placement of Broviac catheters by pediatric critical care physicians in a sedation suite. Earlier studies, mainly of adult patients, have compared cost, complications, and outcomes of central catheters placed by surgeons, anesthesiologists, and interventional radiologists, supporting the economic advantages and scheduling convenience of this method. Slavc and Urban and Skladal et al previously proposed that tunneled CVADs could safely be inserted in children by pediatric intensivists and oncologists. Other data provide evidence that performing this procedure outside of the OR does not compromise safety or sterility.
Our children's hospital operates a high-volume pediatric sedation service, performing over 6,000 sedations annually. Pediatric intensivists insert approximately half of all Broviac catheters placed at our institution. Our Broviac catheter insertion protocol employs two intensivists: one to administer anesthesia and another to place the catheter under sterile conditions. Anesthesia for Broviac insertion is primarily done using propofol, often paired with an opioid analgesic. For patients who do not require any additional surgical procedures, this approach avoids the time and costs associated with the OR and postanesthesia care unit (PACU).
To evaluate the safety and cost-effectiveness of Broviac catheter placement in sedation suites, we reviewed procedural data from our institution and examined the associated billed charges. We present outcomes from several years of experience of Broviac catheter placement in children by trained pediatric intensivists. To our knowledge, no previous study has specifically examined this practice or its financial and patient-safety implications.
The primary aims of the study were to compare cost differences in Broviac catheter placement by surgeons and intensivists and to compare safety outcomes between the two groups of patients. Cost was calculated as the charge for the entire procedure of Broviac catheter placement and was obtained from hospital billing records.
Abstract and Introduction
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.
Design: Single-center retrospective analysis.
Setting: Pediatric sedation suite and operating rooms in a tertiary care children's hospital.
Patients: All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009.
Interventions: None.
Measurements and Main 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.
Introduction
Broviac catheters are widely used in the care of children with malignancies and other chronic illness who require long-term central venous access. These tunneled catheters allow for frequent blood sampling and administration of medication and nutrition in pediatric patients without the discomfort and anxiety of frequent needle sticks. The use and benefits of long-term central venous access devices (CVADs) in children are well established.
Traditionally, Broviac catheters have been placed in patients under general anesthesia by pediatric surgeons in the operating room (OR). This study examines an alternative approach—the placement of Broviac catheters by pediatric critical care physicians in a sedation suite. Earlier studies, mainly of adult patients, have compared cost, complications, and outcomes of central catheters placed by surgeons, anesthesiologists, and interventional radiologists, supporting the economic advantages and scheduling convenience of this method. Slavc and Urban and Skladal et al previously proposed that tunneled CVADs could safely be inserted in children by pediatric intensivists and oncologists. Other data provide evidence that performing this procedure outside of the OR does not compromise safety or sterility.
Our children's hospital operates a high-volume pediatric sedation service, performing over 6,000 sedations annually. Pediatric intensivists insert approximately half of all Broviac catheters placed at our institution. Our Broviac catheter insertion protocol employs two intensivists: one to administer anesthesia and another to place the catheter under sterile conditions. Anesthesia for Broviac insertion is primarily done using propofol, often paired with an opioid analgesic. For patients who do not require any additional surgical procedures, this approach avoids the time and costs associated with the OR and postanesthesia care unit (PACU).
To evaluate the safety and cost-effectiveness of Broviac catheter placement in sedation suites, we reviewed procedural data from our institution and examined the associated billed charges. We present outcomes from several years of experience of Broviac catheter placement in children by trained pediatric intensivists. To our knowledge, no previous study has specifically examined this practice or its financial and patient-safety implications.
The primary aims of the study were to compare cost differences in Broviac catheter placement by surgeons and intensivists and to compare safety outcomes between the two groups of patients. Cost was calculated as the charge for the entire procedure of Broviac catheter placement and was obtained from hospital billing records.
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