Liability related to peripheral venous and arterial catheterization: a closed claims analysis.

BACKGROUND: Serious complications after peripheral IV and arterial vascular cannulations have been reported. To assess liability associated with these peripheral vascular catheters for anesthesiologists, we reviewed claims in the American Society of Anesthesiologists Closed Claims database. METHODS: Claims related to peripheral vascular catheterization were categorized as related to IV or arterial catheters. Complications related to IV catheters were categorized as to type of complication. Patient and case characteristics, severity of injury, and payments were compared between claims related to IV catheters and all other (nonperipheral catheter) claims in the database. Payment amounts were adjusted to 2007-dollar amounts using the consumer price index. RESULTS: Claims related to peripheral vascular catheterization accounted for 2% of claims in the database (n = 140 of 6894 claims), most (91%) associated with IV catheters (n = 127). The most common complications were skin slough (28%), swelling/infection (17%), nerve damage (17%), fasciotomy scars (16%), and air embolism (8%). Approximately half of these complications (55%) occurred after extravasation of drugs or fluids. Compared with other claims, IV claims involved a larger proportion of cardiac surgery (25% vs 2% for other, P < 0.001) and smaller proportion of emergency procedures (8% vs 22% for other, P < 0.001). Claims related to arterial catheters were few (n = 13, 8%), with only seven associated with radial artery catheterization. CONCLUSIONS: Claims related to IV catheters were an important source of liability for anesthesiologists, approximately half of which resulted from extravasation of drugs or fluid. Claims related to radial arterial catheterization were uncommon.

Dual-energy x-ray absorptiometry measurement and accuracy of bone mineral after unilateral total hip arthroplasty.

The standard technique for monitoring bone mineral in hip arthroplasty has been dual-energy x-ray absorptiometry (DEXA). The accuracy of DEXA in the cortical bone adjacent to femoral components has not been established. This study evaluated bone mineral in the cortical bone adjacent to the femoral component comparing DEXA and ashing. Seven pairs of human femora from postmortem donors with unilateral hip implants were examined. Twenty-eight ashed core specimens from both the medial and lateral sides were taken. Cortical bone loss was seen to be greater in the proximal and medial regions of the implanted femora. Dual-energy x-ray absorptiometry failed to show an acceptable level of accuracy compared with ash data (r = 0.56; P = .002). It did show relative patterns of bone loss. Bone loss was consistent with implant-induced stress shielding.