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Complications of Long Arm‐Catheters: A Randomized Trial of Central vs Peripheral Tip Location
Author(s) -
Kearns Patrick J.,
Coleman Steven,
Wehner John H.
Publication year - 1996
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/014860719602000120
Subject(s) - medicine , thrombosis , catheter , surgery , parenteral nutrition , superior vena cava , deep vein , prospective cohort study , peripheral , vein , enteral administration , randomized controlled trial , incidence (geometry) , bloodstream infection , venous thrombosis , physics , optics
Background: This two‐part study initially evaluated complications associated with catheters inserted via upper extremity veins. The second prospective phase compared thrombotic risk of peripheral catheter tips vs a central vein terminus. Methods: Patients from public institutions with infectious diseases were observed throughout their inpatient and outpatient use of IV catheters. Seventy‐two and 39 patients enrolled in phase 1 and phase 2, respectively. Phase 1 consisted of prospective observations and analysis of complications and associated risk factors. Phase 2 randomized patients to a catheter tip location in the superior vena cava or the axillosubclavian‐innominate vein and compared the incidence of thrombosis, phlebitis, and infection. Results: In phase 1, there was an increased risk of thrombosis with peripheral tip localization (61% vs 16%, p <.05). Phase 2 confirmed increased thrombosis with tips in the axillosubclavian‐innominate vein compared with the superior vena cava (60% vs 21%, p <.05) with an improved survival for central tip catheters (p <.02). Catheters associated with thrombosis were more likely to become infected (r = 0.48, p <.02). Conclusions: The experience supports use of the long arm catheter as an effective device for parenteral therapy. A novel method for placing these catheters makes most patients candidates for this approach. Placing a long arm‐catheter's tip in the central venous circulation reduces the risk of thrombosis. A high incidence of tip misdirection indicates a need for radiographic confirmation before use. (Journal of Parenteral and Enteral Nutrition 20 :20–24, 1996)