Peripherally Inserted Central Catheters Placed by Nurses in Hospitalized Patients — Is This a Better Option Than Central Venous Catheters Placed by Physicians?

Background:

Central venous catheters (CVCs) are associated with mechanical and infectious complications and require highly trained personnel for installation. Peripherally inserted central catheters (PICCs) are associated with fewer complications and can be installed by nurses at the bedside, which increases the possibility of central venous access in less complex medical centers and diminishes costs. Previous studies have shown no difference between the 2 devices, but operators were only physicians. The aim was to compare the complications of CVCs installed by physicians versus PICCs installed by nurses in acute hospitalized patients

Methods:

This was a prospective study of 2 cohorts. Hospitalized adults were included who had central vascular access indicated for administration of fluids or medications. Underage patients, oncological patients, and patients who receiving anticoagulation were excluded. The primary outcome was suspected or confirmed catheter‐related bloodstream infection (CRBSI). The secondary outcomes were (1) difficult insertion (more than 2 attempts, nonsignificant hematoma at puncture site, or off‐site installation that required readjustment) and (2) mechanical complications (occlusion, rupture, or dislodgement).The study was approved by the ethics committee and considered the application of informed consent.

Results:

We included 99 patients, with a mean age of 60.2 ± 20.7 years, of whom 45.5% used PICCs and 54.5% CVCs. The CVCs used were subclavian (59.6%) and jugular (40.4%). The average days of use of the devices were 13.5 ± 12.7, and the main indication was fluid administration. Both cohorts were similar. The CVC group had a higher incidence of the primary outcome (28% versus 2%, P = 0.001), mainly because of suspected CRBSI. Thirty‐one percent of the PICC group had difficult insertion versus 7.4% of the CVC group (P = 0.002), and 24% of the PICC group had mechanical complications versus 1.8% of the CVC group (P = 0.0001). Subgroup analysis by type of CVC yielded no significant results

Conclusions:

Suspected or confirmed CRBSI (which usually involves the removal of the device) was 12 times higher within the CVC group. The PICC group presented more installation and maintenance problems, but these were of low clinical impact and could be overcome with better training of nurses. The nurse‐installed PICCs could become an easily accessible alternative for reducing CRBSI, but requires randomized clinical trials to confirm these results.