Central vs peripheral venous catheters in critically ill patients.

A prospective study of 2,209 intravenous catheters was performed in a multidisciplinary intensive care unit to determine when and why catheters were removed and which sites of insertion were associated with the least morbidity. Techniques of insertion were vigorously supervised. Central and peripheral catheters were cared for by identical protocols. Overt phlebitis or inflammation around the site was 14 times as common with peripheral catheters (353/1,024) than with centrally inserted central catheters (18/713), even though peripheral catheters were removed on the average at 2.9 days and centrally inserted central catheters at 6.2 days. Pneumothorax occurred in seven out of 713 patients with centrally inserted central catheterization, one with hemothorax and two with pneumothoraces requiring thoracostomy tubes. Five were treated successfully with simple catheter aspiration. Three patients out of 1,496 with peripheral or peripherally inserted central catheters required phlebectomy for suppurative thrombophlebitis. We concluded that overall morbidity in critically ill patients is lower from centrally inserted central catheters than peripheral intravenous catheters, with peripherally inserted central catheters in an intermediate position. Supervision of techniques of insertion has to be kept at a high level to keep complications of central catheterization at an acceptable level. Peripheral catheter sites would be better maintained with more frequent replacement of the catheter.