Objectives: 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.
Design: Multicenter, controlled, parallel-group, open-label randomized trial.
Setting: Three French ICUs.
Patients: Adult ICU patients with equal central or peripheral venous access requirement.
Intervention: Patients were randomized to receive central venous catheters or peripheral venous catheters as initial venous access.
Measurements and 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.
Conclusion: 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.
1AP–HP, Hôpital Louis Mourier, Service de Réanimation Médico-chirurgicale,Colombes, France.
2Univ Paris Diderot, Sorbonne Paris Cité, UMRS-722, F-75018, Paris, France.
3Département de Santé Publique, Assistance Publique—Hôpitaux de Paris, Hôpital Louis Mourier, Colombes, France.
4Service de Réanimation Médicale, Hôpital Pellegrin—Tripode, Bordeaux, France.
5Assistance Publique—Hôpitaux de Paris, Hôpital Saint-Louis, Service de Réanimation Médicale, Paris, France.
6Département de Biostatistique et Recherche clinique, Assistance Publique—Hôpitaux de Paris, Hôpital Bichat, Paris, France.
Registered at ClinicalTrials.gov: NCT00122707 (http://clinicaltrials.gov/ct2/show/NCT00122707?term=ricard&rank=4).
Drs. Ricard, Salomon, and Dreyfuss designed the study. Drs. Boyer, Thiery, Meybeck, and Le Miere collected data. Drs. Salomon, Roy, and Pasquet analyzed the data. Drs. Ricard, Salomon, and Dreyfuss interpreted the data. Drs. Ricard, Salomon, and Dreyfuss drafted the article. All authors made substantial scientific input to the article. Drs. Ricard, Salomon, and Dreyfuss finalized the article that was approved by all authors. Dr. Ricard had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Supported by a grant devoted to research (Programme Hospitalier de Recherche Clinique) from the French Ministry of Health (AOM02017). The sponsor had no involvement in the study design, data collection, analysis and interpretation, writing of the report, and in the decision to submit the article for publication.
Dr. Ricard is a board member at Covidien, received payment for lectures for Covidien and travel reimbursements from Fisher & Paykel. Dr. Dreyfuss has received grant support from Pfizer. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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