We studied the results of prolonged intravenous therapy with antibiotics
through a central venous silicone-elastomer catheter that had been
peripherally inserted in thirty-five orthopaedic patients. The catheters
remained in place for an average of twenty-nine days (range, five to
seventy-four days). The 20-gauge (one-millimeter-diameter) catheters used
in our study were smaller in diameter than the triple-lumen catheters or
the double-lumen Hickman catheters used in previous studies. The catheters
in our study were left indwelling for as long as, or for longer than, those
in other studies. Our patients had no serious complications related to the
insertion or use of the catheter. However, three (8 per cent) of
thirty-eight inserted catheters failed mechanically and had to be removed.
Two additional catheters (5 per cent) were removed because the lumen became
plugged. One catheter in each of these groups was not replaced, because a
catheter was no longer necessary. We believe that the problems with the
catheters were related to the small diameter of the tubing that was used in
our series. Use of the small-diameter catheter reduces the risk of cardiac
tamponade and other complications associated with catheters that have
larger diameters, and small-diameter catheters can remain indwelling for a
long time. The peripheral route of insertion eliminates the risk of
pneumothorax associated with the subclavian route of placement and allows
for greater ease of insertion. In addition, the use of catheters made of
silicone elastomer reduces the risk of thrombosis and infection, which are
associated with catheters made of polyethylene.(ABSTRACT TRUNCATED AT 250
WORDS)