Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Peripherally Inserted Central Catheters in an Acute-Care Hospital

Peripherally Inserted Central Catheters in an Acute-Care Hospital Abstract Background: Peripherally inserted central catheterization is a relatively new approach for intravenous therapy in acute-care hospitals. Few studies are available on peripherally inserted central catheters (PICCs) used in adult patients in an acute-care setting. We examine the natural history and outcome of PICC use in our hospital. Methods: A retrospective review was undertaken of all hospitalized patients who had PICCs inserted in an acutecare, metropolitan teaching hospital for any reason from July 1991 through July 1992. Patients who had PICCs inserted, used, and then removed in the same hospitalization were evaluated. Results: A total of 135 PICCs were inserted in 114 patients. Six PICCs (4.4%) were inserted in intensive care unit settings and 129 (95.6%) in general medical or surgical service. The mean duration catheters were in place before removal was 14.1 days. Sixty-three catheters (46.7%) were removed following completion of therapy. The rate of PICC-related infection was 2.2% (three catheters). The occlusion rate was higher for 20-gauge catheters (18.4%) than for 18-gauge catheters (8.2%) (P=.08). When the rate of complications was compared as a function of catheter use (total parenteral nutrition vs any other use), there was no statistically significant difference (P=.12). Overall complications related to catheter insertion and removal were uncommon. Conclusions: Based on our study, we conclude that the PICC provides a reasonable and safe alternative to other centrally placed venous devices. In addition, the convenience of maintaining a PICC compared with peripheral intravenous access makes this an attractive method for in-hospital use.(Arch Intern Med. 1994;154:1833-1837) References 1. Bottino J, Mcredie KB, Groschel DHM, Lawson M. Long term intravenous therapy with peripherally inserted silicone elastomer central venous catheters in patients with malignant diseases . Cancer. 1979;43:1937-1943.Crossref 2. Shepherd R. Ong TH. Evaluation of percutaneous inserted peripheral silicone catheters for parenteral nutrition in infants and children . Aust Paediatr . 1980: 16:181-184. 3. Merkel S, Reynen K. Impact on patient care: 2652 PIC catheter days in the alternative setting . J Intravenous Nurs. 1990;13:347-351. 4. Rutherford C. A study of single lumen peripherally inserted central line catheter dwelling time and complications . J Intravenous Nurs. 1988;11:169-173. 5. Goodwin ML. The Seldinger method for PICC insertion . J Intravenous Nurs. 1989;12:238-243. 6. Simon R. Confidence intervals for reporting results of clinical trials . Ann Intern Med. 1986;105:429-435.Crossref 7. Bagnall HA, Gomperts E, Atkinson JB. Continuous infusion of low dose urokinase in the treatment of central venous catheter thrombosis in infants and children . Pediatrics. 1989:83:963-966. 8. Detrich KA, Lobas JG. Use of a single Silastic IV catheter for cystic fibrosis pulmonary exacerbations . Pediatr Pulmonol. 1988;4:181-184.Crossref 9. Zanni RL, Shutack JG, Schuler PM, Vhristie D, Holsclaw DS Jr. Peripherally inserted central venous catheters for treatment of cystic fibrosis . Pediatr Pulmonol . 1985;1:328-332.Crossref 10. Ryan JA, Abel RM, Abbott WM, et al. Catheter complications in total parenteral nutrition: a prospective study of 200 consecutive patients . N Engl J Med. 1974;290:757-761.Crossref 11. Armstrong CW, Mayhall CG, Miller KB, et al. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters . J Infect Dis. 1986;154:808-816.Crossref 12. Sanderson I, Deitel M. Intravenous hyperalimentation without sepsis . Surg Gynecol Obstet . 1973;136:577-585. 13. Pimberton LB, Lyman B, Lander V, Covinsky J. Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients . Arch Surg. 1986;121:591-594.Crossref 14. Sanders RA, Sheldon GF. Septic complications of total parenteral nutrition: a five year experience . Am J Surg. 1976;132:214-220.Crossref 15. Richet H, Hubert B, Nitemberg G, et al. Prospective multicenter study of vascular catheter-related complications and risk factors for positive central catheter cultures in intensive care unit patients . J Clin Microbiol. 1990;28:2520-2525. 16. Giuffrida DJ, Bryan-Brown CW, Lump PD, Kwun KB, Rhoades HM. Central vs peripheral venous catheters in critically ill patients . Chest. 1986;90:806-809.Crossref 17. Maki DG, Ringer M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters . JAMA. 1987;258:2396-2403.Crossref 18. Benezra D, Kiehn TE, Gold JW, Brown AF, Turnbull AD, Armstrong D. Prospective studies of infections in indwelling central venous catheters using quantitative blood cultures . Am J Med. 1988;85:495-498.Crossref 19. Hilton E, Haslett TM, Borenstein MT, Tucci V, Isenberg HD, Singer C. Central catheter infections: single- versus triple-lumen catheters: influence of guide wires on infection rates when used for replacement of catheters . Am J Med. 1988;84:667-672.Crossref 20. Sitges-Serra A, Puig P, Jaurrieta E, Garau J, Alastrue A, Sitges-Creus A. Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition . Surg Gynecol Obstet. 1980;151:481-483. 21. Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous: catheter-related infection . N Engl J Med. 1977;296:1305-1309.Crossref 22. Maki DG, Goldmann DA, Rhame FS. Infection control in intravenous therapy . Ann Intern Med. 1973;79:867-887.Crossref 23. Brown JM. Peripherally inserted central catheters: use in home care . J Intravenous Nurs . 1989;12:144-147. 24. Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters: a randomized controlled trial . Ann Intern Med. 1991; 114:845-854.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Peripherally Inserted Central Catheters in an Acute-Care Hospital

Loading next page...
 
/lp/american-medical-association/peripherally-inserted-central-catheters-in-an-acute-care-hospital-089N8eOmkY

References (26)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420160070009
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Peripherally inserted central catheterization is a relatively new approach for intravenous therapy in acute-care hospitals. Few studies are available on peripherally inserted central catheters (PICCs) used in adult patients in an acute-care setting. We examine the natural history and outcome of PICC use in our hospital. Methods: A retrospective review was undertaken of all hospitalized patients who had PICCs inserted in an acutecare, metropolitan teaching hospital for any reason from July 1991 through July 1992. Patients who had PICCs inserted, used, and then removed in the same hospitalization were evaluated. Results: A total of 135 PICCs were inserted in 114 patients. Six PICCs (4.4%) were inserted in intensive care unit settings and 129 (95.6%) in general medical or surgical service. The mean duration catheters were in place before removal was 14.1 days. Sixty-three catheters (46.7%) were removed following completion of therapy. The rate of PICC-related infection was 2.2% (three catheters). The occlusion rate was higher for 20-gauge catheters (18.4%) than for 18-gauge catheters (8.2%) (P=.08). When the rate of complications was compared as a function of catheter use (total parenteral nutrition vs any other use), there was no statistically significant difference (P=.12). Overall complications related to catheter insertion and removal were uncommon. Conclusions: Based on our study, we conclude that the PICC provides a reasonable and safe alternative to other centrally placed venous devices. In addition, the convenience of maintaining a PICC compared with peripheral intravenous access makes this an attractive method for in-hospital use.(Arch Intern Med. 1994;154:1833-1837) References 1. Bottino J, Mcredie KB, Groschel DHM, Lawson M. Long term intravenous therapy with peripherally inserted silicone elastomer central venous catheters in patients with malignant diseases . Cancer. 1979;43:1937-1943.Crossref 2. Shepherd R. Ong TH. Evaluation of percutaneous inserted peripheral silicone catheters for parenteral nutrition in infants and children . Aust Paediatr . 1980: 16:181-184. 3. Merkel S, Reynen K. Impact on patient care: 2652 PIC catheter days in the alternative setting . J Intravenous Nurs. 1990;13:347-351. 4. Rutherford C. A study of single lumen peripherally inserted central line catheter dwelling time and complications . J Intravenous Nurs. 1988;11:169-173. 5. Goodwin ML. The Seldinger method for PICC insertion . J Intravenous Nurs. 1989;12:238-243. 6. Simon R. Confidence intervals for reporting results of clinical trials . Ann Intern Med. 1986;105:429-435.Crossref 7. Bagnall HA, Gomperts E, Atkinson JB. Continuous infusion of low dose urokinase in the treatment of central venous catheter thrombosis in infants and children . Pediatrics. 1989:83:963-966. 8. Detrich KA, Lobas JG. Use of a single Silastic IV catheter for cystic fibrosis pulmonary exacerbations . Pediatr Pulmonol. 1988;4:181-184.Crossref 9. Zanni RL, Shutack JG, Schuler PM, Vhristie D, Holsclaw DS Jr. Peripherally inserted central venous catheters for treatment of cystic fibrosis . Pediatr Pulmonol . 1985;1:328-332.Crossref 10. Ryan JA, Abel RM, Abbott WM, et al. Catheter complications in total parenteral nutrition: a prospective study of 200 consecutive patients . N Engl J Med. 1974;290:757-761.Crossref 11. Armstrong CW, Mayhall CG, Miller KB, et al. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters . J Infect Dis. 1986;154:808-816.Crossref 12. Sanderson I, Deitel M. Intravenous hyperalimentation without sepsis . Surg Gynecol Obstet . 1973;136:577-585. 13. Pimberton LB, Lyman B, Lander V, Covinsky J. Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients . Arch Surg. 1986;121:591-594.Crossref 14. Sanders RA, Sheldon GF. Septic complications of total parenteral nutrition: a five year experience . Am J Surg. 1976;132:214-220.Crossref 15. Richet H, Hubert B, Nitemberg G, et al. Prospective multicenter study of vascular catheter-related complications and risk factors for positive central catheter cultures in intensive care unit patients . J Clin Microbiol. 1990;28:2520-2525. 16. Giuffrida DJ, Bryan-Brown CW, Lump PD, Kwun KB, Rhoades HM. Central vs peripheral venous catheters in critically ill patients . Chest. 1986;90:806-809.Crossref 17. Maki DG, Ringer M. Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters . JAMA. 1987;258:2396-2403.Crossref 18. Benezra D, Kiehn TE, Gold JW, Brown AF, Turnbull AD, Armstrong D. Prospective studies of infections in indwelling central venous catheters using quantitative blood cultures . Am J Med. 1988;85:495-498.Crossref 19. Hilton E, Haslett TM, Borenstein MT, Tucci V, Isenberg HD, Singer C. Central catheter infections: single- versus triple-lumen catheters: influence of guide wires on infection rates when used for replacement of catheters . Am J Med. 1988;84:667-672.Crossref 20. Sitges-Serra A, Puig P, Jaurrieta E, Garau J, Alastrue A, Sitges-Creus A. Catheter sepsis due to Staphylococcus epidermidis during parenteral nutrition . Surg Gynecol Obstet. 1980;151:481-483. 21. Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous: catheter-related infection . N Engl J Med. 1977;296:1305-1309.Crossref 22. Maki DG, Goldmann DA, Rhame FS. Infection control in intravenous therapy . Ann Intern Med. 1973;79:867-887.Crossref 23. Brown JM. Peripherally inserted central catheters: use in home care . J Intravenous Nurs . 1989;12:144-147. 24. Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters: a randomized controlled trial . Ann Intern Med. 1991; 114:845-854.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 22, 1994

There are no references for this article.