Comparison between peripherally inserted central venous catheters and short-term central venous catheter in patients discharged from the ICU

Introduction

The use of peripherally inserted central catheters (PICCs) in the hospital setting has been indicated as an alternative to the short-term central venous catheter (ST-CVC) in providing prolonged intravenous access. The aim of our study was to assess the rate of complications (deep venous thrombosis (DVT), infections) in patients discharged from the ICU with a PICC or a ST-CVC.

Methods

A total of 239 patients discharged from our ICU (Careggi Teaching Hospital, Florence, Italy) have been followed (March 2007 to December 2008). PICCs were used in 114 patients (PICC group), whereas ST-CVCs were placed in 125 patients (ST-CVC group). Data, expressed as the mean, were analysed with the Mann-Whitney test and Fisher's exact test (P < 0.05).

Results

The PICC group and ST-CVC group resulted similar in age (54.3 vs 58.8), BMI (25.6 vs 26.5), SAPS II (46.2 vs 46.5), and ICU length of stay (17.6 vs 16.4). Admission diagnoses in the PICC and ST-CVC groups were also similar: major trauma (38.6% vs 44.8%), sepsis (37.7% vs 32%), postsurgical complications (23.7% vs 23.2%). Total PICC catheter-days were 4,024, whereas total ST-CVC catheter-days were 2,764. Despite similar demographic and clinical characteristics, the PICC group showed a significantly higher rate of DVT than ST-CVC group (37.7% vs 14.4%; P < 0.01). This difference resulted significant also with catheter-day correction (number of events*1,000/catheter-days). The highest incidence of DTV events occurred after 15 days from placement in both groups.

Conclusions

In our experience, the significant rate of DVT found using PICCs induces one to consider a presumably higher thrombogenicity of this kind of catheter. Based on our result, the use of ST-CVC in patients discharged from the ICU, who are at higher risk of DVT development in regard of the recent critically ill status, might be more appropriate.