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Complications of Long Arm-Catheters: A Randomized Trial of Central vs Peripheral Tip Location

Division of Clinical Nutrition, Santa Clara Valley Medical Center, San Jose, California

Steven Coleman, BS

Michigan State University, School of Osteopathic Medicine, East Lansing

John H. Wehner, MD

Division of Pulmonary Medicine, Stanford University Medical Center, Stanford, California

Background: This two-part study initially evaluated complications associated with catheters inserted via upper extremity veins. The second prospective phase compared thrombotic risk of peripheral catheter tips vs a central vein terminus. Methods: Patients from public institutions with infectious diseases were observed throughout their inpatient and outpatient use of IV catheters. Seventy-two and 39 patients enrolled in phase 1 and phase 2, respectively. Phase 1 consisted of prospective observations and analysis of complications and associated risk factors. Phase 2 randomized patients to a catheter tip location in the superior vena cava or the axillosubclavian-innominate vein and compared the incidence of thrombosis, phlebitis, and infection. Results: In phase 1, there was an increased risk of thrombosis with peripheral tip localization (61% vs 16%, p < .05). Phase 2 confirmed increased thrombosis with tips in the axillosubclavian-innominate vein compared with the superior vena cava (60% vs 21%, p < .05) with an improved survival for central tip catheters (p < .02). Catheters associated with thrombosis were more likely to become infected (r = 0.48, p < .02). Conclusions: The experience supports use of the long arm catheter as an effective device for parenteral therapy. A novel method for placing these catheters makes most patients candidates for this approach. Placing a long arm-catheter's tip in the central venous circulation reduces the risk of thrombosis. A high incidence of tip misdirection indicates a need for radiographic confirmation before use. (Journal of Parenteral and Enteral Nutrition 20:20-24, 1996)

Journal of Parenteral and Enteral Nutrition, Vol. 20, No. 1, 20-24 (1996)
DOI: 10.1177/014860719602000120


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