Clinical utility and cost-effectiveness of protective sleeve pulmonary artery catheters

Abstract

To assess the clinical utility of protective sleeves in pulmonary artery (PA) balloon flotation catheters. Prospective, randomized trial with cost-effectiveness analysis. A general adult ICU in a community teaching hospital. All patients receiving PA balloon flotation catheters over a 1-yr period. Groups 1 and 2 received PA catheters with and without protective sleeves, respectively. Indications for catheter changes, other than catheter malposition, were the same for both groups. In group 1, 54 patients received 71 catheters and four catheters were replaced due to the inability to obtain a PA occlusion pressure (PAOP) tracing. In group 2, 48 patients received 66 catheters, 11 of which were inserted due to failure to obtain a PAOP (p less than .05). PA catheters were repositioned successfully in 37/56 attempts in group 1, compared with 8/20 attempts in group 2 (p less than .05). There was no significant difference in complication rates between the two groups. Even at the increased cost of the protective sleeves and introducer ($7/kit), for 100 catheter insertions, we project a direct cost savings of $742, and personnel time savings of 10.5 hrs for physicians, 14 hrs for nurses, and 4.7 hrs for radiology technicians. Protective sleeves on PA catheters are safe, effective, cost-saving devices for ICU patients.