Cumulative experience with 1,273 peripherally inserted central catheters at a single institution.
OBJECTIVE
To compare bedside insertion of peripherally inserted central catheters (PICCs) by specially-trained nurses with insertion by cardiovascular and interventional radiologists.


METHODS
Nurses performed 327 bedside insertions with a palpatory, through-the-needle technique in 301 patients. Radiologists performed 542 insertions with a venographic-fluoroscopic direct puncture and sheath technique in 354 patients.


RESULTS
A total of 869 PICCs were inserted in 655 patients. Compared with the first interval of the study (reported previously), bedside technical success improved from 74% to 82.6%, technical success decreased from 98.6% to 98.2%, and the service interval for a given PICC decreased from 72.7 to 28.1 days (because PICCs were used instead of peripheral intravenous lines). Rates of thrombophlebitis and infection remained low. Device failure continued to be a problem. About 25% of patients needed insertion of more than one PICC to complete therapy.


CONCLUSIONS
Bedside insertion by specially trained nurses is less costly than insertion by radiologists, but radiologists are needed for difficult initial insertions, PICC salvage, and PICC exchange.
Cardella
J F
JF
Department of Radiology, Pennsylvania State University Hospital, Hershey 17033, USA.
Cardella
K
K
Bacci
N
N
Fox
P S
PS
Post
J H
JH
D002404:Catheterization / Q000009:adverse effects / Q000191:economics / Q000379:methods; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D013924:Thrombophlebitis / Q000453:epidemiology