Cumulative experience with 1,273 peripherally inserted central catheters at a single institution

PURPOSE: To compare bedside insertion of peripherally inserted central catheters (PICCs) by specially-trained nurses with insertion by cardiovascular and interventional radiologists. MATERIALS AND METHODS: Nurses performed 327 bedside insertions with a palpatory, through-the-needle technique in 301 patients. Radiologists performed 542 insertions with a venographic-fluoroscopic direct puncture and sheath technique in 354 patients. RESULTS: A total of 869 PICCs were inserted in 655 patients. Compared with the first interval of the study (reported previously), bedside technical success improved from 74% to 82.6%, technical success decreased from 98.6% to 98.2%, and the service interval for a given PICC decreased from 72.7 to 28.1 days (because PICCs were used instead of peripheral intravenous lines). Rates of thrombophlebitis and infection remained low. Device failure continued to be a problem. About 25% of patients needed insertion of more than one PICC to complete therapy. CONCLUSION: Bedside insertion by specially trained nurses is less costly than insertion by radiologists, but radiologists are needed for difficult initial insertions, PICC salvage, and PICC exchange.