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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial
Jean-Damien Ricard1, Laurence Salomon, Alexandre Boyer
1AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, Colombes, France. jean-damien.ricard@lmr.aphp.fr
Insights
Central venous catheters are associated with fewer major complications than peripheral venous catheters in ICU patients. This study recommends central venous catheters for initial venous access to improve patient safety and reduce adverse events.
Area of Science:
- Critical Care Medicine
- Vascular Access
- Patient Safety
Background:
- Venous access is crucial for intensive care unit (ICU) patients.
- Current guidelines lack evidence-based recommendations for central versus peripheral venous catheter use.
- Different complication profiles exist for central and peripheral venous catheters, creating uncertainty in clinical practice.
Purpose of the Study:
- To compare the rates of catheter-related insertion and maintenance complications between central venous catheters and peripheral venous catheters.
- To determine the optimal initial venous access strategy for ICU patients.
Main Methods:
- A multicenter, controlled, parallel-group, open-label randomized trial was conducted in three French ICUs.
- Adult ICU patients with a need for either central or peripheral venous access were randomized to receive one as initial access.
- The primary endpoint was the rate of major catheter-related complications within 28 days.
Main Results:
- Major catheter-related complications were significantly higher in the peripheral venous catheter group (133) compared to the central venous catheter group (87; p=0.02).
- While not life-threatening, peripheral venous catheters had more complications per patient when used exclusively.
- No significant difference in survival probability was observed between the groups.
Conclusions:
- Central venous catheters are preferably recommended for initial venous access in ICU patients requiring venous access.
- This strategy is associated with a lower rate of major catheter-related complications.
- Further research may refine optimal venous access strategies in critical care settings.
Objectives:
The vast majority of ICU patients require some form of venous access. There are no evidenced-based guidelines concerning the use of either central or peripheral venous catheters, despite very different complications. It remains unknown which to insert in ICU patients. We investigated the rate of catheter-related insertion or maintenance complications in two strategies: one favoring the central venous catheters and the other peripheral venous catheters.
Design:
Multicenter, controlled, parallel-group, open-label randomized trial.
Setting:
Three French ICUs.
Patients:
Adult ICU patients with equal central or peripheral venous access requirement.
Intervention:
Patients were randomized to receive central venous catheters or peripheral venous catheters as initial venous access.
Measurements And Results:
The primary endpoint was the rate of major catheter-related complications within 28 days. Secondary endpoints were the rate of minor catheter-related complications and a composite score-assessing staff utilization and time spent to manage catheter insertions. Analysis was intention to treat. We randomly assigned 135 patients to receive a central venous catheter and 128 patients to receive a peripheral venous catheter. Major catheter-related complications were greater in the peripheral venous catheter than in the central venous catheter group (133 vs 87, respectively, p=0.02) although none of those was life threatening. Minor catheter-related complications were 201 with central venous catheters and 248 with peripheral venous catheters (p=0.06). 46% (60/128) patients were managed throughout their ICU stay with peripheral venous catheters only. There were significantly more peripheral venous catheter-related complications per patient in patients managed solely with peripheral venous catheter than in patients that received peripheral venous catheter and at least one central venous catheter: 1.92 (121/63) versus 1.13 (226/200), p<0.005. There was no difference in central venous catheter-related complications per patient between patients initially randomized to peripheral venous catheters but subsequently crossed-over to central venous catheter and patients randomized to the central venous catheter group. Kaplan-Meier estimates of survival probability did not differ between the two groups.
Conclusion:
In ICU patients with equal central or peripheral venous access requirement, central venous catheters should preferably be inserted: a strategy associated with less major complications.
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