Randomized controlled trial of peripherally inserted central catheters (PICC) versus peripheral catheters (PC) for middle duration in-hospital intravenous therapy.

Author(s): Periard D, Monney P, Waeber G, Zurkinden C, Mazzolai L, Hayoz D, Doenz F, Zanetti G, Wasserfallen JB, Denys A

Affiliation(s): Department of Angiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.

Publication date & source: 2008-06-06, J Thromb Haemost., [Epub ahead of print]

Publication type:

Introduction: Intravenous (IV) therapy may be associated with important catheter-related morbidity and discomfort. The safety, efficacy, comfort and cost-effectiveness of peripherally inserted central catheters (PICC) were compared to peripheral catheters (PC) in a randomized controlled trial. Methods: Hospitalized patients requiring IV therapy >/=5 days were randomized 1:1to PICC or PC. Outcomes were incidence of major complications, minor complications, efficacy of catheters, patients' satisfaction and cost effectiveness. Results: 60 patients were included. Major complications were observed in 22.6% of patients in the PICC group (6 deep venous thrombosis (DVT), 1 insertion-site infection) and 3.4% of patients in the PC group (1 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 in average during 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). IV 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 IV therapy >/= 5 days. However, the risk of DVT, mostly asymptomatic, appears higher than previously reported, and should be considered before using a PICC.