Complications of Long Arm-Catheters: A Randomized Trial of Central vs Peripheral Tip Location

Abstract

Background: This two-part study initially evaluated complications associated with catheters inserted via upper extremity veins. The second prospective phase compared thrombotic risk of peripheral catheter tips vs a central vein terminus. Methods: Patients from public institutions with infectious diseases were observed throughout their inpatient and outpatient use of IV catheters. Seventy-two and 39 patients enrolled in phase 1 and phase 2, respectively. Phase 1 consisted of prospective observations and analysis of complications and associated risk factors. Phase 2 randomized patients to a catheter tip location in the superior vena cava or the axillosubclavian-innominate vein and compared the incidence of thrombosis, phlebitis, and infection. Results: In phase 1, there was an increased risk of thrombosis with peripheral tip localization (61% vs 16%, p < .05). Phase 2 confirmed increased thrombosis with tips in the axillosubclavian-innominate vein compared with the superior vena cava (60% vs 21%, p < .05) with an improved survival for central tip catheters (p < .02). Catheters associated with thrombosis were more likely to become infected (r = 0.48, p < .02). Conclusions: The experience supports use of the long arm catheter as an effective device for parenteral therapy. A novel method for placing these catheters makes most patients candidates for this approach. Placing a long arm-catheter's tip in the central venous circulation reduces the risk of thrombosis. A high incidence of tip misdirection indicates a need for radiographic confirmation before use. (Journal of Parenteral and Enteral Nutrition 20:20-24, 1996)

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References

Webre DR , Arens JF : Use of cephalic and basilic veins for introduction of central venous catheters . Anesthesiology 38:389-392, 1973

MacDonald AS , Master SKP , Moffitt EA : A comparative study of peripherally inserted silicone catheters for parenteral nutrition . Can Anaesth Soc J 24:26.3-269, 1977

Collins RN , Braun PA , Zinner SH , et al: Risk of local and systemic infection with polyethylene intravenous catheters. N Engl J Med 279:340-343; 1968

Merrell SW , Peatross BG , Grossman MD , et al: Peripherally inserted central venous catheters: Low-risk alternatives for ongoing venous access. West J Med 160:25-30, 1994

Hoshal VL Jr : Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters. Arch Surg 110:644-646, 1975

Eisenhauer ED , Derveloy RJ , Hastings PR : Prospective evaluation of central venous pressure (CVP) catheters in a large city-county hospital . Ann Surg 196:560-564, 1982

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 290:757-761, 1974

Seldinger SI : Catheter replacement of the needle in percutaneous arteriography: A new technique. Acta Radiol (Stockh) 39:368-376, 1953

Littleford PO , Spector SD : Device for the rapid insertion of a permanent endocardial pacing electrode through the subclavian vein: Preliminary report . Ann Thorac Surg 27:265-269, 1979

10.

Monreal M. , Lafoz E. , Ruiz J. , et al: Upper-extremity deep venous thrombosis and pulmonary embolism: A prospective study. Chest 99:280-283, 1991

11.

Maki DG , Ringer M. , Alvarado CJ : Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters . Lancet 338:339-343, 1991

12.

Bennegård K. , Curelaru I. , Gustavsson B. , et al: Material thrombogenicity in central venous catheterization. I. A comparison between uncoated and heparin-coated long antebrachial, polyethylene catheters. Acta Anaesthesiol Scand 26:112-120, 1982

13.

Maki DG , Weise CE , Sarafm HW : A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 296:1305-1309, 1977

14.

Snedecor GW , Cochran WG : Statistical Methods, 7th ed. Iowa State University Press, Ames, 1980, pp 144-210

15.

Kaplan EL , Meier P. : Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457-81, 1958

16.

Wilmore DW , Dudrick SJ : Growth and development of an infant receiving all nutrients exclusively by vein. JAMA 203:860-864, 1968

17.

Daily PO , Griepp RB, Shumway NE: Percutaneous internal jugular vein cannulation . Arch Surg 101:534-536, 1970

18.

Graham DR , Keldermans MM , Klemm LW , et al: Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters . Am J Med 91(3B):95S-100S, 1991

19.

Bottino J. , McCredie KB , Groschel DHM , et al: Long-term intravenous therapy with peripherally inserted silicone elastomer central venous catheters in patients with malignant diseases. Cancer 43:1937-1943, 1979

20.

Walters MB , Stanger HAD , Rotem CE : Complications with percutaneous central venous catheters. JAMA 220:1455-1457, 1972

21.

Raad II , Luna M. , Khalil S-AM , et al: The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 271:1014-1016, 1994

22.

Maki DG , Goldman DA , Rhame FS : Infection control in intravenous therapy. Ann Intern Med 79:867-887, 1973

23.

Gould JR , Carloss HW , Skinner WL : Groshong catheter-associated subclavian venous thrombosis. Am J Med 95:419-423, 1993

24.

Lindblad B. , Wolff T. : Infectious complications of percutaneously inserted venous catheters. Acta Anaesthesiol Scand 29:587-589, 1985