ArticlesChanging concepts in long-term central venous access: Catheter selection and cost savings*
Section snippets
Methods
The setting for this study is Akron General Medical Center, which is a 511-bed hospital with 23,400 adult admissions per year, affiliated with Northeastern Ohio Universities College of Medicine. The medical records of patients requiring long-term venous access from 1995 through mid 1997 were evaluated, and patients were followed throughout this period. Complete registries were independently maintained by medical records for surgically placed lines, by the PICC team for all PICCs, and by the
Results
During a 30-month study period, 684 attempted long-term central venous catheter insertions were identified. There were 110 Hickman catheters, 11 subcutaneous ports, and 5 Groshong central catheters attempted. All but 1 Hickman catheter were successfully inserted. A total of 264 PICCs were attempted by the hospital PICC insertion team; 180 were successfully placed. Less than 10% of consults for PICC placement were not attempted as a result of apparently poor peripheral veins. There were 294
Discussion
Many factors need to be considered when selecting the appropriate modality for establishing venous access in a particular patient. Once the need for central venous access is established, a decision should be made regarding whether the need is short-term (generally <2-3 months) or long-term (generally >4 months). Catheter selection is primarily determined by physician preference, taking into account any input by the patient or other staff. Percutaneous subclavian central venous catheters are
Conclusion
Traditional, surgically placed central catheters are increasingly being replaced by peripherally inserted central venous access devices. When clinically feasible, use of PICCs instead of surgically or radiologically placed venous access devices results in fewer severe complications and a substantial cost savings.
Acknowledgements
We acknowledge Valerie Batten, RN, BSN, and Amy Gerber RN, OCN, for their substantial contributions in data collection, making this study possible.
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Reprint requests: Mark C. Horattas, MD, FACS, 400 Wabash Ave, Akron, OH 44307.