Peripherally Inserted Versus Centrally Inserted Central Venous Catheters in the Neurological Intensive Care

Inclusion Criteria: * all patients age \> 18, admitted to the neurological ICU who are require a de novo central venous catheter as standard of care and in which a double lumen 5f PICC or CICVC (triple lumen, 7f) are acceptable for the indication. * the patients must be expected to survive and need a central venous catheter for at least 7 days. Exclusion Criteria: * prisoner * age \< 18 * expected to die or have care withdrawn prior to ICU day 7 * requiring an emergent central venous catheter * suspected bacteremia * recent central venous catheter within the last 30 days * patients who are not a candidate for bedside placement of either a CICVC or PICC line * patients with renal insufficiency with creatinine level greater than 3.0 mg/dL (265.2 m mol/L) or who were undergoing hemodialysis * patients requiring a central venous catheter for prolonged antibiotic therapy\\ * patient who the treating clinician feels clearly needs one particular type of catheter over the other