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This research reported herein is partially supported by a CHSRF/CIHR Genesis Fellowship Award, and Department of Diagnostic Imaging Therapy, Hospital for Sick Children. The authors acknowledge the following individuals who made significant technical contributions toward this study: Nicole-E Brown, Doina Filipescu, May Seto, Mari Acebes-Carcao, Melissa Ortwyn, Barbara Bruinse, Mina Komal, Sanjay Mahant, Leonardo Brandao, and Ziv Shnitzer
Since the introduction of intravenous (IV) therapy, different venous access devices (VADs) have been developed and used increasingly for IV therapy in a wide variety of patients. The range of devices include peripheral IVs, peripherally inserted central catheters (PICC), central venous catheters (CVC), and port-o-caths (ports). Choosing the most suitable device for specific patients in different clinical scenarios is important (1). Repeated IVs are usually easy to insert in adults, more difficult in young children, and require frequent replacements to complete a course of therapy. PICCs provide secure central venous access through a peripheral vein, for short to medium length therapies.
Although the average cost for a peripheral IV (USD$108.49) is much lower than a PICC, patients have higher satisfaction with PICCs (2;3). Complications associated with PICCs are significantly fewer compared with central devices (CVCs or ports) (4). One central VAD is the tunneled CVC, intended for long-term therapy; they are more invasive and usually require general anesthesia or deep sedation to insert. Tunneled CVCs have lower infection rates than nontunneled CVCs (5). If infection occurs, the management costs range from USD$70.60 to USD$198, 993.63 (6). In one study, management of catheter related blood stream infections have exceeded $19,000 CDN per incident (7). The other central VAD is the implantable port, entirely buried under the skin. They are used for long-term intermittent needs. They are more expensive to insert and remove (5). The total insertion costs and charges for central VADs are estimated between USD $1,500 to USD $8,500 (8).
Previous studies commented that a PICC was a safe and cost-effective intervention, with greater reported patient satisfaction for establishing central venous access among adult hospitalized patients than other venous access options (3;9;10). The insertion cost related to a PICC has been estimated at USD $690 per patient (10). Another study reported the total insertion cost ranged from USD $173.6 to USD $440.7 (3). It was estimated...