Variation in Frequency of Intraoperative Arterial, Central Venous and Pulmonary Artery Catheter Placement During Kidney Transplantation: An Analysis of Invasive Monitoring Trends

  • Alexander Nagrebetsky
  • Richard P. Dutton
  • Jesse M. Ehrenfeld
  • Richard D. Urman
Patient Facing Systems
Part of the following topical collections:
  1. Patient Facing Systems


The rapidly increasing number of kidney transplantations warrants assessment of anesthesia care in this patient population. We explored the frequency of arterial catheter (AC), central venous catheter (CVC) and pulmonary artery catheter (PAC) placement during kidney transplantation in the USA using data from the National Anesthesia Clinical Outcomes Registry (NACOR) and assessed the between-facility variation in the frequency of catheter placement. We defined cases of kidney transplantation using Agency for Healthcare Research and Quality Clinical Classification Software. Placement of AC, CVC and PAC was defined by respective Current Procedural Terminology codes. The frequency of vascular catheter placement across facility types was compared using Pearson χ2 test. We identified 10,580 cases of kidney transplantation performed in 100 facilities from January 1, 2010 to December 31, 2014. Placement of an AC was reported in 1700 (16.1%), CVC in 2580 (24.4%) and PAC in 50 (0.5%) of cases. The frequency of placement of specific types of catheters was statistically different across facility types (p < 0.001). Within individual facilities that reported at least 50 cases of kidney transplantation, the percentages of cases performed with AC, CVC and PAC ranged from 0% to 86%, 0% to 90% and 0% to 3%, respectively. Considerable between-facility variation in the frequency of AC, CVC and PAC placement during kidney transplantation raises concerns about the need for better practice standardization. Excess invasive monitoring may represent a safety risk as well as unnecessary additional cost. If kidney transplantation can be safely performed without an AC, CVC or PAC in most patients, facilities with above-average catheter placement rates may have an opportunity for measurable reduction in catheter-related perioperative complications. Optimizing perioperative monitoring is an important component of ensuring high functioning, high-value medical systems.


Kidney transplantation Central venous catheter Arterial catheter Pulmonary artery catheter Hemodynamic monitoring 


Compliance with ethical standards

Conflict of Interest

Richard P. Dutton and Richard D. Urman serve on the Anesthesia Quality Institute’s Data Use Committee. The rest of the authors declare no conflict of interest. Richard D. Urman received funding for unrelated research from Merck, Medtronic, and Mallinckrodt.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was not required given the retrospective and de-identified nature of the data.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Alexander Nagrebetsky
    • 1
  • Richard P. Dutton
    • 2
  • Jesse M. Ehrenfeld
    • 3
  • Richard D. Urman
    • 4
  1. 1.Massachusetts General Hospital/Harvard Medical SchoolBostonUSA
  2. 2.US Anesthesia Partners (USAP)DallasUSA
  3. 3.Vanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s Hospital/Harvard Medical SchoolBostonUSA

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