Purpose
Peripherally inserted central catheters (PICCs) offer certain patients a convenient, safe, and effective long-term intravenous access option [1]. Different methods exist for insertion of a PICC, each offering advantages and challenges [2]. At our institution, approximately 90% of PICCs are inserted in a dedicated angiography suite under fluoroscopic guidance by a combination of staff including medical, nursing, and radiographers. This allows for an aseptic environment where a combination of ultrasound and fluoroscopy can be used. With oversight from interventional radiologists, advanced maneuvers such as direct...
Methods and materials
The Radiology Information System was used to identify 100 continuous PICC insertions in each group (fluoroscopic and blind pushing) between 1 January and 12 May 2019. Patients were excluded if there was a known history of central venous occlusion/stenosis.
For those with fluoroscopic guidance, they were identified using a specific identifier placed in RIS for all PICC insertions. For those without fluoroscopic guidance, chest radiographs were searched and identified when the indication for the radiograph was "PICC insertion". Those without fluoroscopic guidance included locations such...
Results
A total of 200 PICC insertions were included with 100 sequentially in each group of fluoroscopic and non-fluoroscopic.
Summary statistics are shown in Table 1. There was no significant difference in the mean age (p=0.73), gender (p=0.21), or side of access (p=0.88) between the groups.
0% of the fluoroscopic-guided PICCs demonstrated a malpositioned tip compared with 60% of the lines placed using the blind pushing technique and without fluoroscopic guidance, p<0.0001 (Figures 2a-c).
Table 2 shows that fluoroscopic-guided PICC insertions were in place for a...
Conclusion
This study shows that the use of fluoroscopy and a dedicated procedural room for PICC placement leads to significant improvements in tip accuracy and a lower rate of line complications than for using the blind pushing technique performed without fluoroscopic guidance.
While the use of these imaging resources incurs cost and time, these factors should be balanced in order to offer patients the safest and most accurate method of line insertion when possible. For PICC inserters using the blind pushing technique, methods to improve PICC...
References
Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Medicine. 2012;(38):1105
Askey J and Clements W. A Single-Center Experience of Fluoroscopic-Guided Peripherally Inserted Central Catheter Insertion by Nursing Staff: Rationale and Clinical Outcomes. J Rad Nursing. 2019 September. 28(3): pp 155-157. https://doi.org/10.1016/j.jradnu.2019.06.004
Kwon S, Son SM, Lee SH, et al. Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution. Acute Crit Care. 2020 Feb; 35(1):...