title: Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial.
abstract: OBJECTIVE
  The vast majority of ICU patients require some form of venous access. There are no evidenced-based guidelines concerning the use of either central or peripheral venous catheters, despite very different complications. It remains unknown which to insert in ICU patients. We investigated the rate of catheter-related insertion or maintenance complications in two strategies: one favoring the central venous catheters and the other peripheral venous catheters.
  
  
  METHODS
  Multicenter, controlled, parallel-group, open-label randomized trial.
  
  
  METHODS
  Three French ICUs.
  
  
  METHODS
  Adult ICU patients with equal central or peripheral venous access requirement.
  
  
  METHODS
  Patients were randomized to receive central venous catheters or peripheral venous catheters as initial venous access.
  
  
  RESULTS
  The primary endpoint was the rate of major catheter-related complications within 28 days. Secondary endpoints were the rate of minor catheter-related complications and a composite score-assessing staff utilization and time spent to manage catheter insertions. Analysis was intention to treat. We randomly assigned 135 patients to receive a central venous catheter and 128 patients to receive a peripheral venous catheter. Major catheter-related complications were greater in the peripheral venous catheter than in the central venous catheter group (133 vs 87, respectively, p=0.02) although none of those was life threatening. Minor catheter-related complications were 201 with central venous catheters and 248 with peripheral venous catheters (p=0.06). 46% (60/128) patients were managed throughout their ICU stay with peripheral venous catheters only. There were significantly more peripheral venous catheter-related complications per patient in patients managed solely with peripheral venous catheter than in patients that received peripheral venous catheter and at least one central venous catheter: 1.92 (121/63) versus 1.13 (226/200), p<0.005. There was no difference in central venous catheter-related complications per patient between patients initially randomized to peripheral venous catheters but subsequently crossed-over to central venous catheter and patients randomized to the central venous catheter group. Kaplan-Meier estimates of survival probability did not differ between the two groups.
  
  
  CONCLUSIONS
  In ICU patients with equal central or peripheral venous access requirement, central venous catheters should preferably be inserted: a strategy associated with less major complications.
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale, Colombes, France. jean-damien.ricard@lmr.aphp.fr
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Laurence
authors.initials: L
authors.lastname: Salomon
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiery
authors.forename: Agnes
authors.initials: A
authors.lastname: Meybeck
authors.forename: Carine
authors.initials: C
authors.lastname: Roy
authors.forename: Blandine
authors.initials: B
authors.lastname: Pasquet
authors.forename: Eric
authors.initials: E
authors.lastname: Le Mière
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003428:Cross Infection; D018592:Cross-Over Studies; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care