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Impact of arm selection on the incidence of PICC complications: results of a randomized controlled trial

Abstract

Introduction

The aim of this study is to determine if right arm peripherally inserted central catheters (PICCs) experienced fewer complications while controlling for gender, hand dominance, history of malignancy, dwell time and catheter size.

Methods

This was an intention-to-treat randomized controlled trial conducted in an academic medical center on two different sites between September 2012 and September 2015. All patients older than 18 years or age without known history of previous central line, contraindication to the use of a specific arm or hospitalized in the intensive care unit regardless of coagulation status, were considered for the study. Participants were randomized to the left or right arm group and were followed until catheter removal. Data collected included: PICC characteristics, insertion details, gender, arm dominance, history of malignancy, reason for insertion/removal, incidence of a complication and total dwell time. One-tailed hypothesis testing using a univariate logistic regression with odds ratio (OR) calculation was used to analyze the results. There were 202 patients randomly assigned, totaling 7657 catheter-days; 103 patients to the right-side group and 99 patients to the left-side group.

Results

Participants in both groups were statistically equivalent for right handedness, gender, oncologic status, average dwell time and total catheter days. The overall incidence of complications on the right side was 23% versus 34% on the left side, confirming the hypothesis that right-sided insertions led to fewer complications (p = 0.046). The risk of a complication was reduced by 40% with right-sided insertion (OR 0.58 (CI: 0.31-1.09).

Conclusions

This study indicated fewer complications with right-sided insertion irrespective of hand dominance.

J Vasc Access 2017; 18(5): 408 - 414

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/jva.5000738

Authors

France Paquet, Louis-Martin Boucher, David Valenti, Richard Lindsay

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interests: Ms. Paquet reports non-financial support from Vygon, personal fees and non-financial support from Benson Dickinson, personal fees and non-financial support from 3M, non-financial support from Smiths Medical, outside the submitted work. Dr. Boucher reports personal fees and non-financial support from BTG (Therasphere), outside the submitted work. Dr. Valenti reports personal fees and non-financial support from BTG (Therasphere), personal fees and non-financial support from XACT robotics, personal fees from Guerbet, personal fees from Carestream, personal fees and non-financial support from Siemens, personal fees from Covidien, outside the submitted work. Dr. Lindsay has nothing to disclose.

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Authors

Affiliations

  • McGill University Health Centre, Montreal, Quebec - Canada
  • McGill University, Montreal, Quebec - Canada
  • Belfast Health and Social Care Trust, Knockbracken Healthcare, Belfast - UK

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