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Cited by 107Central Venous Catheters and HemodialysisClinical Nutrition and GastroenterologyHemodynamic Monitoring and Therapy

Central or Peripheral Catheters for Initial Venous Access of ICU Patients: A Randomized Controlled Trial

Ricard, Jean-Damien, Salomon, Laurence, Boyer, Alexandre, Thiery, Guillaume, Meybeck, Agnes, Roy, Carine, Pasquet, Blandine, Le Mière, Eric +1 more·2013·Critical Care Medicine
DOI 10.1097/ccm.0b013e31828a42c5
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Abstract

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.

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  • We identified direct evidence from 14 RCTs (n = 4,499 patients) that assessed use of procalcitonin to guide antimicrobial treatment duration in patients with sepsis.

    “We identified direct evidence from 14 RCTs (n = 4,499 patients) that assessed use of procalcitonin to guide antimicrobial treatment duration in patients with sepsis (two trials included critically ill patients in general) (308-321).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [309]

  • A small study randomizing peripheral versus central access found major catheter-related complications were higher with peripheral lines, no significant difference in minor complications, difficulty in placement was the most common peripheral complication, and almost half of the peripheral group did not need a central line during ICU stay.

    “A small study (n = 263) randomly allocated patients to receive peripheral vascular access or a central access [386]. The need for vasopressor was the indication for venous access in 70% of the patients. The incidence of major catheter-related complications was higher in those randomised to peripheral venous lines with no significant difference in the incidence of minor catheter-related complicatio”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [386]

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Authors
Ricard, J.-D., Salomon, L., Boyer, A., Thiery, G., Meybeck, A., Roy, C., Pasquet, B., Le Mière, E., & Dreyfuss, D.
Affiliations
  • Hôpital Louis-Mourier (FR)
  • Hôpital Pellegrin (FR)
  • Assistance Publique – Hôpitaux de Paris (FR)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-09
Volume
41
Issue
9
Pages
2108-2115
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0b013e31828a42c5
OpenAlex
W2031608109
Cited by
104
References
35
Citations by year
2026: 7 · 2025: 8 · 2024: 12 · 2023: 9 · 2022: 13 · 2021: 11 · 2020: 4 · 2019: 8 · 2018: 7 · 2017: 8 · 2016: 5 · 2015: 7 · 2014: 4 · 2013: 1
FWCI
8.78
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords
central venous catheters, peripheral intravenous catheters, catheter-related complications, intensive care unit patients, catheter insertion and maintenance, catheter-related infection
MeSH terms
Aged, Catheterization, Central Venous, Catheterization, Peripheral, Cross Infection, Female, France, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Quality of Health Care, Confidence Intervals, Outcome Assessment, Health Care, Cross-Over Studies

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