The Vitacuff and Intravascular Catheter—Related Infection

To the Editor.—  I read with interest the article by Flowers et al¹ in The Journal. I have several misgivings about the use of the Vitacuff catheter. Guide-wire changes and accepted and effective maintenance technique for central venous catheters and sepsis workups are not possible with the Vitacuff. As a result, the critically ill patient is subjected to repeated "new sticks" and the risks of complications each time a temperature spike occurs. The Vitacuff requires a stab incision for placement. Ten percent of these incisions were not adequate to prevent catheter extrusion in this study. The stab technique is limited to the subclavian approach (stab incisions in the area of the internal jugular or femoral veins are not desirable) and the subclavian approach also carries the highest incidence of pneumothorax. The incidence of candidemia in this study and previous multicenter trials² with the Vitacuff is unacceptable.Fifty-three (49%)