title: Peripherally inserted central catheters with distal versus proximal valves: prospective randomized trial.
abstract: OBJECTIVE
  To evaluate whether peripherally inserted central catheters (PICCs) with a proximal valve have any advantage compared to those with a distal valve in regard to the incidence of occlusion, infection, or malfunction.
  
  
  METHODS
  One hundred patients (mean age, 46 y) were randomized to receive either a distal-valved Bard Groshong catheter (n = 48) or a proximal-valved Catheter Innovations Pressure Activated Safety Valve catheter (n = 52). All catheters were 4-F, single-lumen PICCs. Catheters were placed under fluoroscopic (n = 82) or sonographic (n = 18) guidance. Most (91%) were placed for the administration of antibiotics. The placement procedure, maintenance, and weekly follow-up were the same for both catheters.
  
  
  RESULTS
  Percutaneous placement with the catheter tip in the central veins was successful in all patients. Mean dwell time was 36 days. There were 12 (25%) occlusive or infectious complications in the distal valve catheter group and six (11.5%) in the proximal valve group (P = .08). There were 25 fractures in 17 distal valve catheters (35.4%) and three (5.8%) proximal valve catheter fractures (P < .01).
  
  
  CONCLUSIONS
  There was a marked difference in durability between the valved catheters, in favor of the catheter with a proximal valve. There was also a trend for fewer occlusive and infectious complications with the proximal valve catheter.
authors.affiliation: Department of Radiology, Section of Vascular and Interventional Radiology, Box 359728, Harborview Medical Center, 325 9th Avenue, Seattle, Washington 98104, USA. rhoffer@u.washington.edu
authors.forename: E K
authors.initials: EK
authors.lastname: Hoffer
authors.forename: R D
authors.initials: RD
authors.lastname: Bloch
authors.forename: J J
authors.initials: JJ
authors.lastname: Borsa
authors.forename: P
authors.initials: P
authors.lastname: Santulli
authors.forename: A B
authors.initials: AB
authors.lastname: Fontaine
authors.forename: N
authors.initials: N
authors.lastname: Francoeur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional