Peripherally inserted central catheters: Outcome as a function of the operator

PURPOSE: To determine the natural history of and outcome involved with peri pherally inserted central catheters (PICCs) placed at a single institution and examine potential differences in the natural history of PICCs placed by interventional radiologists (IRs) versus registered nurses (RNs). MATERIALS AND METHODS: A prospective analysis of all patients receiving PIC Cs at one academic medical center over a period of 6.5 months was conducted . At our institution, PICCs are placed primarily by RN members of the intra venous team. Placement procedures deemed unfeasible or problematic by RNs a re referred to an IR for insertion under fluoroscopic guidance. A total of 322 PICCs (130 by IRs, 192 by RNs) were successfully placed in 256 patients . In three patients, placement was attempted but was a technical failure by both RNs and IRs. Seven patients in each group were lost to follow-up. PIC Cs were classified as successfully completed therapy or as having been prem aturely removed, which was further stratified into suspected infection, occ lusion, phlebitis, mechanical failure, inadvertent patient removal, and oth er. RESULTS: Overall rate of premature removal for PICCs placed by IRs versus R Ns was not significantly different (30.8% vs 23.4%, respectively). PICCs pl aced by IRs had an increased rate of occlusion (IRs = 9.2%, RNs = 3.6%; P = .02). Other reasons for premature removal did not differ in incidence. Over all, PICCs were successfully placed in 99.1% of all patients and the course of therapy was completed in 69.3%. CONCLUSION: It is reasonable and cost-effective for trained RNs to place PI CCs whenever feasible and refer complicated placements to IRs.