A pressure-resistant peripherally inserted central catheter is as useful as a central venous catheter for rapid fluid infusion: an in vitro study

Abstract

Background: Although peripherally inserted central catheters (PICCs) have been widely used, they have not been frequently used in anesthesia practice. The central venous pressure measured via PICCs are reportedly as accurate as that measured via central venous catheters (CVCs), but the findings concerning rapid infusion are unclear. This study examined whether or not pressure-resistant PICCs could be used for rapid fluid infusion. METHODS: The in-line pressure was measured in similar-sized double-lumen catheters-4-Fr PICC (55, 45 and 35 cm) and 17-G CVC (20 and 13 cm)-at flow rates of saline decided using a roller pump system. We also examined the flow rate at an in-line pressure of 300 mmHg, which is the critical pressure at which hemolysis is considered to occur during blood transfusion.

Results: The pressure-resistant PICCs obtained a high flow rate similar to that of CVCs, but the in-line pressures increased in proportion to the flow rate and catheter length. Flow rates at an intra-circuit pressure of 300 mmHg were not significantly different between the 45-cm PICC and 20-cm CVC.

Conclusion: Pressure-resistant PICCs can be used for rapid fluid infusion.

Keywords: Blood transfusion; Central venous catheter (CVC); Fluid infusion; Peripherally inserted central catheter (PICC); Rapid fluid infusion.

Fig. 1

A schematic illustration of infusion circuit for measuring in-line pressure. The circuit to infuse normal saline consisted of a blood transfusion set, a roller pump system and a three-way stopcock connected to the main lumen of a catheter. A pressure gauge was connected to the stopcock. The second lumen of the catheter was perfused with normal saline using an infusion pump

Fig. 2

Relationships between the flow rates and in-line pressure. (a) Triangles and (b) circles show in-line pressures at indicated flow rates in 55-, 45- and 35-cm peripherally inserted central catheters (PICCs) and 20- and 13-cm central venous catheters (CVCs). (c) In-line pressures at the indicated flow rates in the 45-cm PICC (gray triangles) were compared with those in CVCs (filled circles). Data are shown as the average ± SEM, and significant differences are represented by * (p < 0.05)

Fig. 3

A comparison of the flow rates at an in-line pressure of 300 mmHg. The flow rates at an in-line pressure of 300 mmHg were compared between a 20-cm central venous catheter (CVC) and 45-cm peripherally inserted central catheter (PICC). The flow rates were not significantly different between these catheters (p < 0.05). Data are shown as the average ± SEM. n.s., not significantly different