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Peripherally inserted central venous catheters. Low-risk alternatives for ongoing venous access
S W Merrell1, B G Peatross, M D Grossman
1Surgical Service, Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148.
The Western Journal of Medicine
|January 1, 1994
Summary
Peripherally inserted central venous catheters offer safe and reliable long-term venous access for elderly veterans. These catheters were successfully used in most patients, with few serious complications, making them a preferred choice.
Area of Science:
- Vascular Access Devices
- Medical Device Safety
- Geriatric Medicine
Background:
- Central venous catheters are crucial for prolonged venous access in medical and surgical patients.
- Peripherally inserted central venous catheters (PICCs) offer a less invasive alternative to traditional central lines.
- Evaluating the efficacy and safety of PICCs in specific patient populations is essential.
Purpose of the Study:
- To prospectively evaluate the use and safety of peripherally inserted central venous catheters (PICCs) for ongoing venous access.
- To assess the success rate, tip placement, duration of use, and complication profile of PICCs in a veteran population.
- To compare the utility of PICCs with other central venous access methods.
Main Methods:
- Prospective evaluation of PICC insertions in general medical and surgical patients at a Department of Veterans Affairs medical center.
- Trained nurses performed catheter insertions, with success rates and tip placement documented.
- Data collected on duration of use, home use, reasons for removal, and types of complications.
Main Results:
- Successful insertion rate of 85.4% (393/460 patients) by trained nurses.
- Correct or adequate catheter tip placement achieved in 91.3% of insertions.
- Mean catheter use duration of 27.6 days, with 65 patients using them at home for an average of 36.2 days.
- Catheter-related complications led to premature removal in 21% of cases, with bland phlebitis and occlusion being most common (8.2% each).
- No deaths were attributed to catheter use; one patient required vein excision for suppurative phlebitis.
Conclusions:
- Peripherally inserted central venous catheters provide reliable and safe vascular access for extended periods in an elderly veteran population.
- PICCs are a valuable alternative to percutaneous and surgically implanted central venous catheters, reserved for cases where PICCs cannot be placed.
- The study supports the routine use of PICCs for long-term venous access in this demographic, minimizing the need for more invasive procedures.