Peripherally inserted central venous catheters in critical care patients.

Abstract

OBJECTIVE: To describe the clinical outcomes and cost for high-risk critical care patients with peripherally inserted central venous catheters (PICCs). DESIGN: A prospective descriptive study. SETTING: A private acute care facility. SUBJECTS: Ninety-seven consecutive PICC insertions in four critical care units per physician order. Five subjects were excluded due to five abortive attempts. Data were analyzed on 92 PICC insertions. Age range was 23 to 92 years. OUTCOME MEASURES: Frequency of insertion complications, postinsertion complications, and cost factors were measured. RESULTS: When subjects were in critical care areas, catheters remained in place a mean of 10 days with a range of one to 50 days. After patient transfer with catheters in place to acute care areas (medical-surgical units), convalescent units, and home care, catheters were maintained a mean of 13 days with a range of 1 to 116 days. Catheter days totaled 2069. The total number of catheter days while in critical care were 878, with 1191 catheter days after transfer to other areas. Seventy-one of the original 92 PICC catheters remained in place until treatment was completed or the patient expired. Twenty-one were removed for nonelective reasons. Of these patients, only one had significant morbidity related to sepsis. This septic episode occurred in a convalescent unit. Percentage of catheter-related sepsis was 0.48% per 1000 catheter days. Because PICCs are not used to any degree in critical care patients throughout the United States, this study should increase awareness among practitioners that this approach is a safe alternative method to chest or neck insertion for central venous access in high-risk critical care patients.