Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Randomized Controlled Trial Multicenter Study
Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters.
Central venous access devices (CVADs) allow intravenous therapy, haemodynamic monitoring and blood sampling but many fail before therapy completion. ⋯ In 1892 CVADs, all-cause failure occurred in 10.2% of devices: 49 NTCVADs (6.1%); 100 PICCs (13.2%); 44 TCVADs (13.4%). Failure rates for CLABSI, occlusion and dislodgement were 5.3%, 1.8%, and 1.7%, respectively. Independent CLABSI predictors were blood product administration through PICCs (hazard ratio (HR) 2.62, 95% confidence interval (CI) 1.24-5.55); and in TCVADs, one or two lumens, compared with three to four (HR 3.36, 95%CI 1.68-6.71), intravenous chemotherapy (HR 2.96, 95%CI 1.31-6.68), and diabetes (HR 3.25, 95%CI 1.40-7.57). Independent factors protective for CLABSI include antimicrobial NTCVADs (HR 0.23, 95%CI 0.08-0.63) and lipids in TCVADs (HR 0.32, 95%CI 0.14-0.72). NTCVADs inserted at another hospital (HR 7.06, 95%CI 1.48-33.7) and baseline infection in patients with PICCs (HR 2.72, 95%CI 1.08-6.83) were predictors for dislodgement. No independent occlusion predictors were found. Modifiable risk factors were identified for CVAD failure, which occurred for 1-in-10 catheters. Strict infection prevention measures and improved CVAD securement could reduce CLABSI and dislodgement risk.
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In 2010, Congress enacted the Patient Protection and Affordable Care Act (ACA) to enhance health insurance affordability via subsidies and Medicaid expansion (ME). However, not all states adopted ME. We examined national hospital readmissions from 2005 to 2019 to investigate readmission reduction trends based on state ME status. ⋯ Using a difference-in-difference framework and adjusting for hospital and population characteristics, we assessed the relationship between ME and 30-day readmissions following pneumonia, heart failure (HF), and acute myocardial infarction (AMI) hospitalizations. Both before and after the expansion, ME-States had higher mean readmission rates than non-ME-States. After ME, hospitals in ME-States exhibited larger reductions in readmission rates compared to non-ACA States: pneumonia (-0.12%; 95% confidence interval [CI] = -0.19%, -0.04%; p = .002), HF (-0.18%; 95% CI = -0.28%, -0.08%; p = .001), and AMI (-0.23%; 95% CI = -0.32%, -0.13%; p < .001).