Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy.

Link to article at PubMed

Related Articles

Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy.

J Thromb Haemost. 2008 Aug;6(8):1281-8

Authors: Periard D, Monney P, Waeber G, Zurkinden C, Mazzolai L, Hayoz D, Doenz F, Zanetti G, Wasserfallen JB, Denys A

INTRODUCTION: Intravenous (i.v.) therapy may be associated with important catheter-related morbidity and discomfort. The safety, efficacy, comfort, and cost-effectiveness of peripherally inserted central catheters (PICCs) were compared to peripheral catheters (PCs) in a randomized controlled trial. METHODS: Hospitalized patients requiring i.v. therapy >or= five days were randomized 1:1 to PICC or PC. Outcomes were incidence of major complications, minor complications, efficacy of catheters, patient satisfaction, and cost-effectiveness. RESULTS: 60 patients were included. Major complications were observed in 22.6% of patients in the PICC group [six deep venous thrombosis (DVT), one insertion-site infection] and 3.4% of patients in the PC group [one DVT; risk ratio (RR) 6.6; P = 0.03]. Superficial venous thrombosis (SVT) occurred in 29.0% of patients in the PICC group and 37.9% of patients in the PC group (RR 0.60; P = 0.20). Patients in the PICC group required 1.16 catheters on average during the study period, compared with 1.97 in the PC group (P < 0.04). The mean number of venipunctures (catheter insertion and blood sampling) was 1.36 in the PICC group vs. 8.25 in the PC group (P < 0.001). Intravenous drug administration was considered very or quite satisfying by 96.8% of the patients in the PICC group, and 79.3% in the PC group. Insertion and maintenance mean cost was 690 US$ for PICC and 237 US$ for PC. DISCUSSION: PICC is efficient and satisfying for hospitalized patients requiring i.v. therapy >or= five days. However, the risk of DVT, mostly asymptomatic, appears higher than previously reported, and should be considered before using a PICC.

PMID: 18541001 [PubMed - indexed for MEDLINE]

2 Comments

  1. More info needed on the study design: What time dates for data collection? Who placed PICC and PC? Specialist or not? What patient population? ICU or Oncology or Surgical? Techniques of PICC placement? MST or U/S used ? Guess I need to see the whole article.

  2. The article (http://www3.interscience.wiley.com/cgi-bin/fulltext/120119224/HTMLSTART) randomized consecutive admissions to an internal medicine service with a range of diagnoses who were anticipated to require IV treatments for 5 days or more. PICC lines were placed by interventional radiologists in a procedure suite using fluoroscopy and ultrasound; peripheral IV’s were placed by nurses at the bedside. Because of the small number enrolled, there was appreciable diagnostic heterogeneity across the two groups that did not necessarily reach statistical significance (for example, 5/16.1% of PICC patients had cancer, versus 3/10.3% of peripheral IV patients), which may underlie some of the discrepancy in outcomes (although DVT formation in particular did not appear to correlate with particular diagnoses significantly). DVT’s were treated in appropriate patients with 6 weeks of anticoagulation after catheter removal, which may not be uniform practice for asymptomatic catheter-associated DVT’s.

Leave a Reply

Your email address will not be published. Required fields are marked *