The Cost of Vascular Access Complications
Potential savings with Access Vascular Technology
Vascular access complications are far too common and have a devastating impact on both the patient experience and on hospital economics.
New data helps quantify the true cost of complications and the potential savings with new catheter materials.
Integrative Review Published in the International Journal of Nursing Health Care Research1
Objectives
The aim of this integrative review was to:
Identify the benchmark incidence of top three complication outcomes with PICC and midline catheters for thrombosis, infection, and occlusion.
To identify their associated costs
Project the potential economic impact of catheter hydrogel materials on reduction of catheter related complications.
How may construction materials contribute to complication incidence and cost?
Methodology
Literature review and systematic search of PICC and midline outcomes, materials and economics was performed using keywords for peer-reviewed publications that met the inclusion criteria.
Economic analysis was performed using PICC outcome costs in the MedPAR 2020 final data released by CMS using identified ICD-10 procedure codes in conjunction with diagnosis codes for top PICC complications.
Literature Review Process
10,635 articles were initially identified and after review of abstracts then full text articles was narrowed to 75 articles across three categories:
PICC/midline outcomes, Catheter materials, and Economic impact
Economic Analysis Process
Claims data in the analysis was the MedPAR 2020 final data released by the Centers for Medicare and Medicaid services.
ICD-10 procedure codes for PICC insertion were identified along with primary or secondary diagnosis codes for catheter-related complications including catheter-related thrombosis; bloodstream infection; and catheter occlusion (procedure code was utilized to identify tPA use).
Complications and Economics Analysis Results
More than 264,000 catheters were reported in the literature reviewed.
From a national view, with an estimated 2.8M PICC insertions and 1.1M midline insertions per year, applying the pooled overall complication rate and weighted cost of $20,684 per episode equates to a total cost of vascular access complications of $4.5 billion dollars per year.
From a hospital view, the total costs associated with the three reviewed complications for PICCs and midlines when applying the identified cost per incident and the identified complication rate was:
Over $1.1 million in a 300-bed hospital
Over $3.7 million in a 1000-bed hospital
A key driver of cost was catheter-related thrombosis which was projected at more than $600K in a 300-bed hospital and more than $2 million dollars in a 1,000-bed hospital.
Materials Review Results
The materials literature review of 28 publications revealed the majority of vascular catheters are constructed mostly of polyurethane and silicone which are hydrophobic and highly susceptible to protein adsorption.
Catheters prepared from these materials are prone to the foreign body response leading to various failure modes such as phlebitis, thrombosis and thrombotic occlusion.
Masking the disadvantages of the hydrophobic materials by modifying the surface of the catheter with hydrophilic coatings and impregnating the catheter with antimicrobial or thromboresistant additives are some common approaches however, retrospective reviews of outcomes resulted in no appreciable change in catheter occlusions.
The HydroPICC and HydroMID biomaterial catheters are not coated but are made from a composite hydrophilic material featuring MIMIX™ technology that demonstrated the ideal characteristics of thromboresistance in research.
Conclusion
Expenditures for common vascular access complications can quickly add up and contribute $3.7 million or more in avoidable costs to a large hospital.
A consistently hydrophilic catheter material, in contrast to polyurethane materials commonly used for these catheters, may reduce blood cell adherence, bacterial attachment and catheter complications.
The use of consistently hydrophilic PICC or midline catheters in acute care could result in savings of nearly $1.8M annually for a typical 1000-bed acute care facility or $560K for a 300-bed acute care facility with a modest 50% reduction in complication costs.
Moureau NL (2022). International Journal of Nursing Health Care Research 5: 1347. DOI: https://doi.org/10.29011/2688-9501.101347
Investigation was sponsored by Access Vascular Inc. The funding organization had no role in the conduct of the study, the management, interpretation of the data, or decision to submit the manuscript for publication.
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