Device selection: a critical strategy in the reduction of catheter-related complications.

Medical science has made dramatic strides in the use of innovative drug therapies to improve the lives of patients with life-threatening and chronic illnesses. As new therapies have evolved, so has the way in which they are administered. The transition of care from hospital to home and cost competition forced the home infusion industry to find safe, cost-effective methods to deliver parenteral therapy. Medical device technology has met the challenge with several new devices alternatives. Almost at the same time, three new peripheral device options were introduced: the midline catheter, the peripherally inserted central venous catheter (PICC) , and the peripheral port. While these devices are proving to be safe, cost-effective methods for delivery of parenteral therapy, confusion exists regarding the appropriate use, care and management among the various access devices. Traditionally, device selection was based primarily on the need for short-term or long-term access. Peripheral intravenous catheters were used until venipuncture was no longer possible. Central venous catheters were used only for hemodynamic monitoring in the critically ill, when parenteral nutrition or chemotherapy required prolonged access, or when peripheral veins were exhausted. Now the issues are different; multiple drug regimens are administered in alternate care settings with variable lengths and frequencies of drug administration, multiple device options are available each with variable risks, non-medical caregivers provide care and administer parenteral drugs