Central Catheters Preferable to Peripheral Catheters in the ICU

Albert B. Lowenfels, MD


January 09, 2014

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

Ricard JD, Salomon L, Boyer A, et al
Crit Care Med. 2013;41:2108-2815


Is a central venous catheter (CVC) preferable to a peripheral venous catheter (PVC) in managing patients in the intensive care unit (ICU)? The authors compared major and minor complications in 135 patients who were randomly assigned to receive CVCs with 128 patients assigned to receive PVCs. At least one major complication developed in 64% of patients in the CVC group compared with 99% of patients in the PVC group. However, the number of serious or life-threatening complications was similar between the 2 groups, and the overall mortality rates were also similar.


Considering the large number of catheters inserted worldwide, it is surprising that this study appears to be the first randomized trial comparing 2 alternative insertion measures. The evidence seems to favor CVC insertion. Using this approach initially would have avoided a crossover from the PVC group to the CVC group in one half of the patients who were originally assigned to the PVC group. It is reassuring that the overall mortality was similar in the 2 groups, implying that it is safe to consider either procedure for patients in an ICU setting.