title: Prospective randomized comparative evaluation of proximal valve polyurethane and distal valve silicone peripherally inserted central catheters.
abstract: OBJECTIVE
  The objective of this study was to evaluate and compare the relative durability and complications between the proximal valve polyurethane and distal valve silicone peripherally inserted central catheters (PICCs).
  
  
  METHODS
  Institutional review board approval was obtained. A total of 326 patients (mean age, 50.4 years) was assigned randomly to receive either a proximal valve polyurethane PICC (n = 198) or a distal valve silicone Groshong PICC (n = 194). All PICCs were inserted under radiologic guidance by interventional radiologists. Follow-up data were collected until catheter removal because of complications or treatment completion.
  
  
  RESULTS
  The mean catheter dwell time was 25.6 days (range, 1-245 days). Complications were encountered in 26.8% and 47.9% of the proximal valve polyurethane PICCs and distal valve silicone PICCs, respectively (P < .001). Significantly higher incidences of phlebitis (23.2% versus 11.6%, P = .003) and catheter-related infection (6.2% versus 2%, P = 0.043) were noted in the distal valve silicone PICCs. No significant differences in the incidence of catheter occlusion, fracture, or dislodgement were found. Multivariate logistic regression analysis showed a higher complication rate in the distal valve silicone PICCs corrected for patients' age, sex, underlying morbidity, indication, peripheral vein accessed, arm used, catheter tip placement, and the number of venepunctures attempted.
  
  
  CONCLUSIONS
  Proximal valve polyurethane PICCs were more durable than distal valve silicone PICCs, which were associated with a higher incidence of phlebitis and infection, probably related to the materials of the catheters and the designs and placements of the catheter valves.
authors.affiliation: Department of Diagnostic Imaging, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore. ongck22@hotmail.com
authors.forename: Cheng K
authors.initials: CK
authors.lastname: Ong
authors.forename: Sudhakar K
authors.initials: SK
authors.lastname: Venkatesh
authors.forename: Gabriel B
authors.initials: GB
authors.lastname: Lau
authors.forename: Shih C
authors.initials: SC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D016009:Chi-Square Distribution; D020878:Device Removal; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000209:etiology; D011140:Polyurethanes; D011446:Prospective Studies; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D012828:Silicones; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D055815:Young Adult
chemical_list: D011140:Polyurethanes; D012828:Silicones