PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS - LOW-RISK ALTERNATIVES FOR ONGOING VENOUS ACCESS

We prospectively evaluated the use of peripherally inserted central ve nous catheters to provide ongoing venous access in general medical and surgical patients in a Department of Veterans Affairs medical center. Between 1985 and 1988 trained nurses successfully inserted 393 cathet ers in 460 suitable patients (an 85.4% success rate). Correct catheter tip placement in the superior vena cava was documented in 359 of the 393 (91.3%) catheter insertions, but an additional 30 catheters were i n a position deemed adequate for the intended use. The mean duration o f catheter use was 27.6 +/- 5.2 (1 standard deviation) days (median 20 days, range 1 to 370 days). A total of 65 patients left the hospital with catheters in place, with the mean length of catheter use at home being 36.2 +/- 6.0 days (range 2 to 266). In all, 79% of the catheters were in use until the successful completion of therapy or patient dea th; catheter-related complications led to premature catheter removal i n the remaining 21%. Catheter-related complications included bland phl ebitis (8.2%), occlusion (8.2%), local infection (3.6%), bacteremia or fungemia (2.1%), mechanical failure or rupture (2.6%), venous thrombo sis (0.7%), and other (3.3%). One patient required vein excision for t he management of suppurative phlebitis, but no deaths were attributed to catheter use. This study illustrates the use and safety of peripher ally inserted central venous catheters to provide reliable vascular ac cess over prolonged periods in an elderly veteran population. At our f acility, percutaneous central venous catheters and surgically implante d (Hickman or Broviac) catheters are now reserved for use in patients in whom peripherally inserted catheters cannot be placed.