Peripherally Inserted Central Catheters with Distal versus Proximal Valves: Prospective Randomized Trial

Abstract

To evaluate whether peripherally inserted central catheters (PICCs) with a proximal valve have any advantage compared to those with a distal valve in regard to the incidence of occlusion, infection, or malfunction. One hundred patients (mean age, 46 y) were randomized to receive either a distal-valved Bard Groshong catheter (n = 48) or a proximal-valved Catheter Innovations Pressure Activated Safety Valve catheter (n = 52). All catheters were 4-F, single-lumen PICCs. Catheters were placed under fluoroscopic (n = 82) or sonographic (n = 18) guidance. Most (91%) were placed for the administration of antibiotics. The placement procedure, maintenance, and weekly follow-up were the same for both catheters. Percutaneous placement with the catheter tip in the central veins was successful in all patients. Mean dwell time was 36 days. There were 12 (25%) occlusive or infectious complications in the distal valve catheter group and six (11.5%) in the proximal valve group (P = .08). There were 25 fractures in 17 distal valve catheters (35.4%) and three (5.8%) proximal valve catheter fractures (P < .01). There was a marked difference in durability between the valved catheters, in favor of the catheter with a proximal valve. There was also a trend for fewer occlusive and infectious complications with the proximal valve catheter.