Raad et al1 presented an interesting discussion of the utility of nontunneled Silastic central venous catheters. Of particular note was the fact that this product offered the potential for a long duration (109 days) and a low infection rate (0.13 per 100 catheter days) at a considerable cost advantage compared with tunneled Hickman catheters.
Two issues deserve comment, however. First, it would have been valuable to also offer insertion data, especially the success and complication rates, to better evaluate their true cost relative to other central venous catheters.
At our institution, we have developed a physician-based peripherally inserted central catheter service, and we rely heavily on the peripherally inserted central catheters as an alternative to tunneled catheters. Our insertion success rate, based on the ability to pass a functional catheter, is 96% over 1200 catheter requests. Attempts are made on all requests for catheter placement, and no requests are