PERIPHERALLY INSERTED CENTRAL CATHETERS IN GENERAL MEDICINE

Objective: To report the success rate and complications associated wit h peripherally inserted central venous catheters (PICCs) and to compar e costs between PICCs and centrally inserted central catheters. Materi al and Methods: We undertook a cohort study of the first 1,000 patient s referred to the PICC service of a large tertiary-care, university-af filiated, community hospital. The data were analyzed for insertion suc cess rate, insertion mode, complication rate, successful completion, i nsertion costs, and applicability of PICCs in ''high-risk'' groups (tr ansplant, human immunodeficiency virus-infected, intensive-care unit, and pediatric populations). Results: Of 1,000 consecutive PICC attempt s, 963 (96.3%) were successful. Cutdown procedures mere necessary in 1 41 insertions (14.6%). Complications of PICC placement occurred in 170 cases (17.7%). Among the major complications were a need for multiple attempts at insertion in 92 cases, malpositioning in 56, mechanical p hlebitis in 37, clotting in 37, and bleeding in 5. The rate for comple tion of therapy was 68.9%. Frequent reasons for early termination were dislodgment (in 85 cases) and infection (in 72-37 confirmed and 35 po tential cases). The rate of confirmed infection was 11 per 10,000 cath eter days. The costs of PICC insertion were less than those associated with centrally inserted central catheters. Conclusion: PICCs can sati sfy long-term vascular needs and are safe in many patient populations. The infection rate did not depend on insertion mode, lumen number, or patient's immune status. Use of total parenteral nutrition was the mo st important risk factor in all patient subsets. Cost and safety consi derations strongly favor PICCs as alternatives to other vascular acces s devices.