Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy |
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Authors: | D. PERIARD,P. MONNEY&dagger ,G. WAEBER&dagger ,C. ZURKINDEN&dagger ,L. MAZZOLAI,D. HAYOZ,F. DOENZ§ ,G. ZANETTI&Dagger ,J.-B. WASSERFALLEN&dagger , A. DENYS§ |
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Affiliation: | Departments of Angiology;;Internal Medicine;;Radiology;;and Hospital Preventive Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland |
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Abstract: | Summary. Introduction: Intravenous (i.v.) therapy may be associated with important catheter-related morbidity and discomfort. The safety, efficacy, comfort, and cost-effectiveness of peripherally inserted central catheters (PICCs) were compared to peripheral catheters (PCs) in a randomized controlled trial. Methods: Hospitalized patients requiring i.v. therapy ≥ five days were randomized 1:1 to PICC or PC. Outcomes were incidence of major complications, minor complications, efficacy of catheters, patient satisfaction, and cost-effectiveness. Results: 60 patients were included. Major complications were observed in 22.6% of patients in the PICC group [six deep venous thrombosis (DVT), one insertion-site infection] and 3.4% of patients in the PC group [one DVT; risk ratio (RR) 6.6; P = 0.03]. Superficial venous thrombosis (SVT) occurred in 29.0% of patients in the PICC group and 37.9% of patients in the PC group (RR 0.60; P = 0.20). Patients in the PICC group required 1.16 catheters on average during the study period, compared with 1.97 in the PC group ( P < 0.04). The mean number of venipunctures (catheter insertion and blood sampling) was 1.36 in the PICC group vs. 8.25 in the PC group ( P < 0.001). Intravenous drug administration was considered very or quite satisfying by 96.8% of the patients in the PICC group, and 79.3% in the PC group. Insertion and maintenance mean cost was 690 US$ for PICC and 237 US$ for PC. Discussion: PICC is efficient and satisfying for hospitalized patients requiring i.v. therapy ≥ five days. However, the risk of DVT, mostly asymptomatic, appears higher than previously reported, and should be considered before using a PICC. |
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Keywords: | cost-effectiveness analysis infection peripheral catheter peripherally inserted central catheter (PICC) satisfaction questionnaire thrombosis |
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