Peripherally inserted central catheters with distal versus proximal valves: Prospective randomized trial

PURPOSE: To evaluate whether peripherally inserted central catheters (PICCs ) with a proximal valve have any advantage compared to those with a distal valve in regard to the incidence of occlusion, infection, or malfunction. MATERIALS AND METHODS: One hundred patients (mean age, 46 y) were randomize d to receive either a distal-valved Bard Groshong catheter (n = 48) or a pr oximal-valved Catheter Innovations Pressure Activated Safety Valve catheter (n = 52). All catheters were 4-F, single-lumen PICCs. Catheters were place d under fluoroscopic (n = 82) or sonographic (n = 18) guidance. Most (91%) were placed for the administration of antibiotics. The placement procedure, maintenance, and weekly follow-up were the same for both catheters. RESULTS: Percutaneous placement with the catheter tip in the central veins was successful in all patients. Mean dwell time was 36 days. There were 12 (25%) occlusive or infectious complications in the distal valve catheter gr oup and six (11.5%) in the proximal valve group (P = .08). There were 25 fr actures in 17 distal valve catheters (35.4%) and three (5.8%) proximal valv e catheter fractures (P < .01). CONCLUSION: There was a marked difference in durability between the valved catheters, in favor of the catheter with a proximal valve. There was also a trend for fewer occlusive and infectious complications with the proximal v alve catheter.