EFFICACY OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS PLACED IN NONCENTRAL VEINS

Background: Peripherally inserted central venous catheters (PICCs) are commonly used intravenous access devices in children. Although PICCs are intended to be placed in central veins, many fail to reach this lo cation. These noncentral PICCs are used for administration of medicati ons and isotonic solutions. Objectives: To examine the efficacy of non central PICCs for completion of therapy, the complications associated with their use, and the effectiveness of noncentral PICCs as compared with PICCs placed in a central vein. Design: A prospective cohort stud y of children in whom PICCs were inserted, from January 1, 1994, to Ja nuary 1, 1996. Setting: A university-affiliated teaching institution. Main Outcome Measurement: Completion of intravenous therapy. Results: A total of 587 PICCs were studied. Thirty-nine percent of PICCs were p laced in noncentral veins. Centrally placed PICCs had significantly lo nger catheter duration compared with those placed noncentrally (16.6 v s 11.4 days, respectively). However, central and noncentral PICCs had similar therapy completion rates (73% and 69%, respectively). Catheter failure because of occlusion and accidental dislodgment were similar for central and noncentral PICCs. Likewise, complications caused by ex it-site infection, phlebitis, and catheter-associated sepsis were also similar for catheters in the 2 locations. Catheter survival curves we re similar for central and noncentral PICCs. Conclusions: Our study de monstrates that PICCs placed in noncentral veins provide reliable and safe intravenous access for administration of many medications and iso tonic solutions for about 2 weeks' duration. The placement of PICCs in central veins may be restricted to those children who need central va scular access because of the type of intended therapy.