title: Prospective randomized comparison of valved versus nonvalved peripherally inserted central vein catheters.
abstract: OBJECTIVE
  The purpose of this study was to evaluate whether a valved peripherally inserted central catheter (PICC) design would result in a lower incidence of occlusion, infection, and malfunction than a clamped catheter.
  
  
  METHODS
  Three hundred sixty-two study patients (233 men, 129 women; mean age, 44 years) were randomized to receive a clamped (n = 182) or valved (n = 180) 5-French single-lumen PICC. Catheters were placed under fluoroscopic (n = 331) or sonographic guidance (n = 31). The valved PICC was flushed with saline solution, and the clamped PICC was flushed with a heparin-saline solution. All patients were prospectively followed up at least weekly for catheter status and complications.
  
  
  RESULTS
  Percutaneous placement with the catheter tip in the central veins was successful in 99% of patients. Mean dwell time was 34 days. Twenty-six occlusive or infectious complications occurred in the clamped catheter group and 12 in the valved catheter group (p = .02). The clamped and valved catheter groups had 13 and five occlusions, respectively (p = .06), and 12 and five catheter-related blood stream infections, respectively (p = .09). Most occlusions (68%) were treated successfully with urokinase, and site infection or sepsis was treated by catheter removal.
  
  
  CONCLUSIONS
  We found a statistically significant difference in the complication rate for the valved PICC compared with the clamped PICC. With the valved PICC, occlusion and infection were reduced, and patients having these catheters did not require heparin flushes.
authors.affiliation: Department of Radiology, Harborview Medical Center, Seattle, WA 98104, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Hoffer
authors.forename: J
authors.initials: J
authors.lastname: Borsa
authors.forename: P
authors.initials: P
authors.lastname: Santulli
authors.forename: R
authors.initials: R
authors.lastname: Bloch
authors.forename: A B
authors.initials: AB
authors.lastname: Fontaine
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies