No abstract

We read with interest the letter published by Reuter et al 1 about the Voi-Réa study, describing the ICU "life" expectance of peripheral venous catheters (PVCs) previously inserted in emergency departments and in prehospital settings. This issue is very important for patients and nurses in the ICU. We are sincerely concerned about the results of this study, because we didn't expect such a high percentage of PVC retention (28%) and deferred replacement (12%). The ICU setting is characterized by high levels of organ and system support and the administration of a large amount and different types of drug infusions (eg, vasoactive agents, sedatives, antibiotics, and sometimes parenteral nutrition). The simultaneous administration of these medications, the problems related to osmolality of some solutions, and their potential incompatibility often make PVCs inadequate for use in the ICU. 2 Multilumen short-term central venous catheters (CVCs) and, in selected cases, peripherally inserted central venous catheters (PICCs) offer the chance to manage the patients' multiple infusions with higher standards of safety than those provided by PVCs. Moreover, the Infusion Nurses Society recommends that PCV insertion site assessment in critically ill patients be performed at least every 1 or 2 hours. 3 This recommendation increases the nursing workload.Even if the authors claim the absence of short-term risks associated with PVC maintenance, we don't understand why a PVC should be replaced and not removed in favor of other intravascular devices as a CVC or PICC. 1 Moreover, CVCs and PICCs are inserted with ultrasound guidance, thus avoiding multiple punctures, risk of complications, material waste, and unnecessary pain for patients.It seems to be a paradox to talk about the pertinence of the setting of care, that a patient transferred from the emergency department to the ICU only needs a PVC to get treatment.

Introduzione: con il termine delirio si intende, in Terapia Intensiva (ICU), una sindrome che può colpire numerosi pazienti ricoverati in queste strutture e la cui sottovalutazione può portare ad aumento dei tempi di ventilazione, aumento della morbilità e della mortalità.