Comparison of the outcomes of central venous catheters inserted from the left side and right side: a prospective randomized controlled study

Objective To compare the effectiveness and safety of central venous catheters inserted from the left side and right side during peripheral inserted central catheterizations (PICC). Methods Totally 458 adult patients undergoing PICC between May 2007 and May 2008 were enrolled in this study and divided randomly into right-sided group (n = 228)and left-slded group (n = 230). Chest X-ray was performed immediately after catheterization to identify the initial tip locations. Other parameters were evaluated during follow-up. Results The rate of difficult insertion was significantly lower in right-sided group than in left-sided group (14.9% vs 24. 8% , P =0.003). The rate of tip projection angle ＞40°was also significantly lower in right-sided group (2.2% vs 23.4% ,P = 0. 000). The rate of tips reaching the central veins was not significantly different between two groups (54.4%vs 53.0% , P = 0. 538). Compared with right-sided catheters, the tip positions in the left-sided group was significantly less frequently located in the inferior segment of superior vena cave in the central tip locations (6. 6% vs 21.0% , P =0. 001)and more commonly positioned in the nominate vein in non-central tip locations (66. 7% vs 48.1% , P = 0. 008). In addition, the catheter detaining time (P = 0. 617), incidence of local phlebitis after puncture (P = 0. 561), catheter obstruction rate (P = 0. 774), and catheter-related infection rate (P = 0. 854)showed no significant differences between two groups. The incidence of swollen limb was significantly lower inright-sided group than in left-sided group (4. 4% vs 8.3%, P = 0. 043). Conclusions Right-sided catheters provide better outcomes than left-sided catheters. PICC through the right elbow veins should be preferred in clinical practices. Key words: Peripheral inserted central catheterizations; Right upper limb; Left upper limb; Outcome; Prospective,randomized controlled study