Jw. Parker et Rw. Gaines, LONG-TERM INTRAVENOUS THERAPY WITH USE OF PERIPHERALLY INSERTED SILICONE-ELASTOMER CATHETERS IN ORTHOPEDIC PATIENTS, Journal of bone and joint surgery. American volume, 77A(4), 1995, pp. 572-577
We studied the results of prolonged intravenous therapy with antibioti
cs through a central venous silicone-elastomer catheter that had been
peripherally inserted in thirty-five orthopaedic patients. The cathete
rs remained in place for an average of twenty-nine days (range, five t
o seventy-four days). The 20-gauge (one-millimeter-diameter) catheters
used in our study were smaller in diameter than the triple-lumen cath
eters or the double-lumen Hickman catheters used in previous studies.
The catheters in our study were left indwelling for as long as, or for
longer than, those in other studies. Our patients had no serious comp
lications related to the insertion or use of the catheter. However, th
ree (8 per cent) of thirty-eight inserted catheters failed mechanicall
y and had to be removed. Two additional catheters (5 per cent) were re
moved because the lumen became plugged. One catheter in each of these
groups was not replaced, because a catheter was no longer necessary. W
e believe that the problems with the catheters were related to the sma
ll diameter of the tubing that was used in our series. Use of the smal
l-diameter catheter reduces the risk of cardiac tamponade and other co
mplications associated with catheters that have larger diameters, and
small-diameter catheters can remain indwelling for a long time. The pe
ripheral route of insertion eliminates the risk of pneumothorax associ
ated with the subclavian route of placement and allows for greater eas
e of insertion. In addition, the use of catheters made of silicone ela
stomer reduces the risk of thrombosis and infection, which are associa
ted with catheters made of polyethylene. We found that long-term centr
al venous access with small-gauge silicone-elastomer catheters that we
re peripherally inserted was associated with an acceptably low rate of
complications in our patients. Thus, we recommend the use of these ca
theters in orthopaedic patients who need prolonged intravenous therapy
.