Midline or long peripheral catheters in difficult venous access conditions? A comparative study in patients with acute cardiovascular diseases - 22/09/20
Highlights |
• | The placement of a peripheral catheter may sometimes be challenging, so that patients risk multiple failed attempts. |
• | The US-guided placement of midline or long-peripheral catheters are effective solutions for difficult venous access patients. |
• | Midline catheters allow for longer uncomplicated indwelling times than long-peripheral catheters of different lengths. |
• | The choice of the device should be tailored for each patient by considering the planned therapy, the clinical condition, and the cost of the device. |
• | This strategy may reduce catheter-related complications and avoid patients’ discomfort, while control healthcare costs. |
Résumé |
Background |
Midline catheters (MCs) are commonly inserted in patients with difficult venous access (DVA) needing peripheral access. Recently, the alternative placement of ultrasound-guided long peripheral catheters (LPCs) has spread. However, no study has compared the reliability of the 2 devices. This study aims to compare the safety and reliability of MCs and LPCs in DVA patients.
Methods |
A retrospective cohort study was conducted, enrolling 184 DVA patients. Polyurethane MCs and 2 lengths of polyethylene LPCs (8/10 cm and 18 cm) were compared. The independent effect of catheter type on uncomplicated catheter survival was determined through a Cox regression analysis.
Results |
The relative incidences of overall catheter-related complications (CRCs) were 15.84 of 1,000, 10.64 of 1,000, and 6.27 of 1,000 catheter-days for 8/10 cm-LPCs, 18 cm-LPCs, and MCs, respectively. The relative incidences of catheter-related bloodstream infections were 0.72 of 1,000 for both length LPCs and 0.48 of 1,000 catheter-days for MCs. Compared to MCs, a significant increase in CRC risk for 8/10 cm LPCs (hazard ratio [HR] 5.328; 95% confidence interval [CI] 2.118-13.404; P < 0.001) was found, along with a nonsignificant trend toward an increased risk for 18 cm-LCPs (HR 2.489; 95% CI 0.961-6.448; P = 0.060).
Conclusion |
MCs allow for longer uncomplicated indwelling times than LPCs. The decision regarding which catheter to use should consider the planned duration of intravenous therapy, the patient's clinical condition, and the cost of the device.
Le texte complet de cet article est disponible en PDF.Key Words : Catheter-related thrombosis, Catheter-related blood stream infection, Complication, Catheter survival, Incidence, Indwelling time
Plan
| Conflict of interest: None to report. |
|
| Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. |
Vol 48 - N° 10
P. 1158-1165 - octobre 2020 Retour au numéro
Article précédent
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- Previous peripherally inserted central catheter (PICC) placement as a risk factor for PICC-associated bloodstream infections
- Kwangmin Kim, Youngkyun Kim, Kyong Ran Peck
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