title: Peripherally inserted central catheters: outcome as a function of the operator.
abstract: OBJECTIVE
  To determine the natural history of and outcome involved with peripherally inserted central catheters (PICCs) placed at a single institution and examine potential differences in the natural history of PICCs placed by interventional radiologists (IRs) versus registered nurses (RNs).
  
  
  METHODS
  A prospective analysis of all patients receiving PICCs at one academic medical center over a period of 6.5 months was conducted. At our institution, PICCs are placed primarily by RN members of the intravenous team. Placement procedures deemed unfeasible or problematic by RNs are referred to an IR for insertion under fluoroscopic guidance. A total of 322 PICCs (130 by IRs, 192 by RNs) were successfully placed in 256 patients. In three patients, placement was attempted but was a technical failure by both RNs and IRS: Seven patients in each group were lost to follow-up. PICCs were classified as successfully completed therapy or as having been prematurely removed, which was further stratified into suspected infection, occlusion, phlebitis, mechanical failure, inadvertent patient removal, and other.
  
  
  RESULTS
  Overall rate of premature removal for PICCs placed by IRs versus RNs was not significantly different (30.8% vs 23.4%, respectively). PICCs placed by IRs had an increased rate of occlusion (IRs = 9.2%, RNs = 3.6%; P =.02). Other reasons for premature removal did not differ in incidence. Overall, PICCs were successfully placed in 99.1% of all patients and the course of therapy was completed in 69.3%.
  
  
  CONCLUSIONS
  It is reasonable and cost-effective for trained RNs to place PICCs whenever feasible and refer complicated placements to IRS:
authors.affiliation: Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, USA. nep@alum.dartmouth.org
authors.forename: N I
authors.initials: NI
authors.lastname: Fong
authors.forename: S R
authors.initials: SR
authors.lastname: Holtzman
authors.forename: M A
authors.initials: MA
authors.lastname: Bettmann
authors.forename: S J
authors.initials: SJ
authors.lastname: Bettis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000451:nursing; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000451:nursing; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009726:Nurses; D011183:Postoperative Complications; D011446:Prospective Studies; D015642:Radiology, Interventional; D016019:Survival Analysis; D016896:Treatment Outcome