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Peripherally inserted central catheters with distal versus proximal valves: prospective randomized trial
E K Hoffer1, R D Bloch, J J Borsa
1Department of Radiology, Section of Vascular and Interventional Radiology, Box 359728, Harborview Medical Center, 325 9th Avenue, Seattle, Washington 98104, USA. rhoffer@u.washington.edu
Journal of Vascular and Interventional Radiology : JVIR
|October 5, 2001
Summary
Peripherally inserted central catheters (PICCs) with proximal valves showed better durability and a trend toward fewer complications than those with distal valves. This suggests proximal valves may offer an advantage for long-term use.
Area of Science:
- Vascular Access Devices
- Medical Device Engineering
- Infectious Disease Prevention
Background:
- Peripherally inserted central catheters (PICCs) are crucial for long-term intravenous therapy.
- Catheter design, particularly valve placement, may influence complication rates and device durability.
- Understanding the comparative performance of different valved PICC designs is essential for optimizing patient care.
Purpose of the Study:
- To compare the efficacy of peripherally inserted central catheters (PICCs) with proximal valves versus distal valves.
- To evaluate differences in occlusion, infection, and malfunction rates between proximal and distal valved PICCs.
- To assess the durability and fracture incidence of proximal versus distal valved PICCs.
Main Methods:
- A randomized trial involving 100 patients comparing proximal-valved (n=52) and distal-valved (n=48) single-lumen 4-F PICCs.
- Catheter placement guided by fluoroscopy or sonography, primarily for antibiotic administration.
- Standardized procedures for placement, maintenance, and follow-up for both catheter types.
Main Results:
- All 100 patients achieved successful percutaneous placement with the catheter tip in central veins.
- The proximal valve group experienced fewer occlusive/infectious complications (11.5%) compared to the distal valve group (25%), though not statistically significant (P = .08).
- A significant difference in catheter fractures was observed, with 5.8% in the proximal valve group versus 35.4% in the distal valve group (P < .01).
Conclusions:
- Proximal-valved PICCs demonstrated significantly superior durability compared to distal-valved PICCs.
- A trend suggests proximal-valved PICCs may be associated with fewer occlusive and infectious complications.
- The findings indicate a preference for proximal-valved PICCs due to improved device longevity and potentially reduced complication rates.