Peripherally inserted central catheters for parenteral nutrition: A comparison with centrally inserted catheters

Background: Central venous access is crucial for the provision of adequate parenteral nutrition (PN). The type of central venous access device (CVAD) has evolved over the past 10 years. The most recent trend has been to use p eripherally inserted central catheters (PICCs). This development has occurr ed without controlled clinical trials. Methods: Over a 10-year period, the nutrition support service at a single institution has prospectively collect ed data on CVADs used for providing PN. The types of CVAD used for providin g PN were analyzed, and the major complications associated with CVADs, thro mbosis and line sepsis, were compared over three different time periods: 19 88-1989; 1992-1993; 1996-1997. In addition, complications associated with P ICCs were compared with other CVADs. Results: The following were the domina nt CVADs over each of the three time periods: 1988-1989: tunneled catheters , 80%; 1992-1993: nontunneled catheters, 46%; and 1996-1997: PICCs, 48%. Th ere was a decreased incidence of sepsis and pneumothorax in 1996-1997 and a n increase in severed or leaking catheters and phlebitis. In a comparison o f PICC and non-PICO catheters over the past 3 years, there was a trend towa rd decreasing sepsis with PICC catheters but an increase in malposition, in advertent removal, and severed or leaking catheters. Conclusions: PICCs hav e replaced tunneled and nontunneled central catheters as the most commonly used CVAD for providing PN. PICCs do not result in increased line sepsis or thrombosis but have an increased incidence of local complications such as leaking catheters, phlebitis, and malposition.