scholarly journals Experience of Radiology Technologists Performing Peripherally Inserted Central Catheters (PICC)

2021 ◽  
Author(s):  
I. Aljediea ◽  
M. Alshehri ◽  
K. Alenazi ◽  
A. Memesh ◽  
M. Fleet
Keyword(s):  
Interventional Radiology ◽  
Success Rate ◽  
Ultrasound Guidance ◽  
Review Process ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Venous Puncture ◽  
Local Experience ◽  
Chest X Ray ◽  
Central Catheters

Abstract Purpose We conducted this study to review our local experience of performing peripherally inserted central catheters by interventional radiology technologists. Materials and Methods This is a retrospective study of peripherally inserted central catheters performed by interventional radiology technologists. These procedures were performed using ultrasound guidance for venous puncture and fluoroscopy or electrocardiography guidance followed by chest X-ray to confirm tip location. Results We reviewed all peripherally inserted central catheters performed in interventional radiology between May 2017 and July 2020. The review process included the success rate, number of venous puncture attempts, method of guidance, procedure time, fluoroscopy time, catheter duration to removal, and complications. Conclusion Interventional radiology technologists can perform peripherally inserted central catheters safely with high success rate. Extending interventional radiology technologists' role to perform peripherally inserted central catheters allow interventional radiologists to do more complex procedures. This enhances the workflow, increases the interventional radiology team efficiency, and improves the waiting time.

Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

2018 ◽  
Vol 19 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Soshi Nakamuta ◽  
Toshihiro Nishizawa ◽  
Shiori Matsuhashi ◽  
Arata Shimizu ◽  
Toshio Uraoka ◽  
...  
Keyword(s):  
Success Rate ◽  
Detection Rate ◽  
Ultrasound Guidance ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Ultrasound Guided ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

Randomized multicenter study on long-term complications of peripherally inserted central catheters positioned by electrocardiographic technique

2020 ◽  
Vol 35 (8) ◽  
pp. 614-622
Author(s):  
Yu-Xia Yin ◽  
Wei Gao ◽  
Xu-Ying Li ◽  
Wei Lu ◽  
Qian-Hong Deng ◽  
...  
Keyword(s):  
Control Group ◽  
Exit Site ◽  
Peripherally Inserted Central Catheters ◽  
Exit Site Infection ◽  
X Ray ◽  
Length Estimation ◽  
Chest X Ray ◽  
Central Catheters

Background The intracavitary electrocardiogram (IC-ECG) method has been used for the tip location of central venous access devices for the advantage of being safe, accurate and highly cost effective. However, long-term follow-up is rare. This randomized clinical trial aimed to evaluate the long-term complications of peripherally inserted central catheters (PICCs) positioned by the IC-ECG method. Methods We randomized 2250 patients who needed PICC placement to either a landmark length estimation supplemented by IC-ECG positioned group (ECG group) or the traditional landmark length estimation alone group (control group) in a 2:1 allocation. Post-procedural chest X-rays were applied to confirm tip position. Follow-up was performed monthly to six months. Standard statistics analyses were performed with the SAS 9.13 software, and p < 0.05 was considered significant. Results As evaluated by post-procedural chest X-ray, tip location in the ECG group had a first-attempt success (catheter tip located at optimal position) of 91.7% (95% confidence interval (CI): 90.3%–93.1%), significantly higher than 78.9% (95% CI: 76.0%–81.9%) observed in the control group (p < 0.001). At six-month follow-up, in the control group, frequency of total complications was 9.5%, including the exit site infection (4.0%), phlebitis (1.3%), deep venous thrombosis (1.5%), liquid extravasation (2.9%) and mechanical failure (1.9%). The IC-ECG group had significantly lower rates of complications (6.4%, p < 0.001), including the exit site infection (2.7%, p > 0.05), phlebitis (1.1%, p > 0.05), deep venous thrombosis (1.2%, p > 0.05), liquid extravasation (2.4%, p > 0.05) and mechanical failure (1.2%, p > 0.05). In the univariable logistic regression analysis, ECG method, other diseases and upper arms were the independent protective factors, and the number of adjustment procedures (n ≥ 2) were the independent risk factors of the complications. Conclusions The intra-procedural tip location by IC-ECG is more safe and accurate than the traditional method of verifying tip location only post-procedurally, by chest X-ray.

scholarly journals Insertion of peripherally inserted central catheters with intracavitary electrocardiogram guidance: A randomized multicenter study in China

2018 ◽  
Vol 20 (5) ◽  
pp. 524-529 ◽  
Author(s):  
Yu-Xia Yin ◽  
Wei Gao ◽  
Xu-Ying Li ◽  
Wei Lu ◽  
Qian-Hong Deng ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Multicenter Study ◽  
Anatomical Landmark ◽  
Control Group ◽  
Study Group ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Ultrasound Device ◽  
Chest X Ray ◽  
Central Catheters

Introduction: Ultrasound-guided venipuncture and tip location by intracavitary electrocardiogram have many advantages during the insertion of peripherally inserted central catheters, both in terms of safety and cost-effectiveness. Recently, a new tip-conductive peripherally inserted central catheters and new Doppler ultrasound device integrated with intracavitary electrocardiogram have been introduced into clinical practice in China. A randomized multicenter study (clinical trial no. NCT03230357) was performed to verify the feasibility and accuracy of intracavitary electrocardiogram, as performed with this new peripherally inserted central catheters and device. Methods: Our study enrolled a total of 2250 adult patients in 10 different Chinese hospitals. The patients were randomly assigned to either the study group (intracavitary electrocardiogram) or the control group (anatomical landmark guidance) in a 2:1 allocation. Ultrasound was used in both groups for venipuncture and tip navigation. All patients underwent chest X-ray after the procedure to verify the position of the catheter tip. Results: No insertion-related complications were reported in either group. In the study group, first-attempt successful tip location was 91.7% (95% confidence interval: 90.3%–93.1%), significantly higher than 78.9% (95% confidence interval: 76.0%–81.9%) observed in the control group (p < 0.001). As evaluated by post-procedural chest X-ray, tip location in the study group had a sensitivity of 99.3% (95% confidence interval: 98.8%–99.7%), significantly higher than 86.8% (95% confidence interval: 84.4%–89.2%) observed in the anatomical landmark group (p < 0.001). Conclusion: These results indicated that during peripherally inserted central catheters insertion in adult patients, tip location with intracavitary electrocardiogram guidance, as carried out by a new tip-conductive peripherally inserted central catheters and intracavitary electrocardiogram integrated ultrasound device, was more effective and more accurate than tip location using anatomical landmarks.

Reduction of Malposition in Peripherally Inserted Central Catheters With Tip Location System

2007 ◽  
Vol 12 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Christine L. Naylor
Keyword(s):  
Interventional Radiology ◽  
Right Atrial ◽  
Memorial Hospital ◽  
Staff Satisfaction ◽  
Common Occurrence ◽  
Labor Costs ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Malposition ◽  
The Right ◽  
Central Catheters

Abstract Catheter malposition is a common occurrence with the insertion of peripherally inserted central catheters (PICCs). Santa Rosa Memorial Hospital (SRMH) in Santa Rosa, California, trialed and implemented a new tip location device to evaluate whether malposition rates could be reduced. This article compares 6 months of data. Three of these months were compiled before using the tip locator device. The right atrial malposition rate remained consistent at 18% with or without the use of the tip locator device. All other malpositions were 13.4% without use of the tip locator. The overall malposition rate was 2.5% with the use of the tip locator device. By using this technology, supply and labor costs were reduced, as were referrals to interventional radiology and delays in treatment. Overall staff satisfaction improved.

Ultrasound to Localize the Peripherally Inserted Central Catheter Tip Position in Newborn Infants

2019 ◽  
Author(s):  
Xiao-Ling Ren ◽  
Hong-Lei Li ◽  
Jing Liu ◽  
Ya-Juan Chen ◽  
Man Wang ◽  
...  
Keyword(s):  
Newborn Infants ◽  
X Ray ◽  
Ultrasound Localization ◽  
The Past ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Tip Position ◽  
The Right ◽  
Central Catheters ◽  
The Ideal

Objective To evaluate the application of ultrasound for the localization of the tip position of peripherally inserted central catheters (PICCs) in newborn infants. Study Design This study was a retrospective analysis on ultrasonic localization for PICC placement conducted in our department over the past 2 years. Ultrasonic localization was performed immediately after PICC placement in all neonatal patients. Successful PICC placement was confirmed if the PICC tip position was located at the inferior/superior cavoatrial junction. Chest X-ray localization was performed on 32 infants immediately after ultrasound examination to compare the accuracy of ultrasound localization. Results Of the 186 patients, 174 (93.5%) had successful PICC placement on the first attempt. In 11 (5.9%) patients, the catheter tip was placed beyond the ideal location as follows: too deep (in the right atrium) in 4 patients, too shallow in 4 patients, and malpositioned in 3 patients. Both the sensitivity and the specificity of ultrasound for identifying PICC tip localization were 100%. Complications occurred in 2.7% of this group of patients. Conclusion Ultrasonic localization of the PICC tip position is a timely, accurate, and reliable method and can identify the catheter tip with high accuracy. This method could be widely applied in neonatal wards.

Peripherally Inserted Central Catheters in the Intensive Care Unit

1996 ◽  
Vol 11 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Philip K. Ng ◽  
Mark J. Ault ◽  
Lawrence S. Maldonado
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Success Rate ◽  
Complication Rate ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Venous Access ◽  
Success Rates ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians requested a PICC service consultation were included. Main outcome measurements included (1) the success rate for initial PICC placement, (2) the placement complication rate, and (3) the overall success and complication rate. Of the 91 consecutive attempts at PICC placement, 89 (97.8%) were successful: of the 89 successful placements, 25 (28%) required cutdown procedures. There were 20 complications of initial placement and 8 delayed complications, which occurred in 19 PICCs. Complications included recatheterization after first attempt was unsuccessful (10), catheter malposition (7), palpitations or catheter clotting (3 each), heavy bleeding or mechanical phlebitis (2 each), and arterial puncture (1). The overall success rate for completion of therapy using the PICC was 74.7%. The most frequent reasons for failure to complete therapy were catheter dislodgment in 8 patients and “infection” in 9 patients. Of these 9 patients with “infections,” 8 catheters were discontinued due to potential infection, and only 1 was removed due to confirmed infection. The confirmed infection rate was 6/10,000 patient days. The PICC appears to be a reasonable alternative to other approaches to peripheral and central venous access. The initial and overall success rates from this preliminary study justify' further evaluation of the PICC in critically ill patients.

scholarly journals Catheter Fracture and Embolization Related to an Arm Venous Port

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Brent E. Burbridge
Keyword(s):  
Breast Cancer ◽  
Interventional Radiology ◽  
Venous Catheter ◽  
Fluoroscopic Guidance ◽  
X Ray ◽  
Radiology Suite ◽  
Interventional Radiology Suite ◽  
Chest X Ray ◽  
Catheter Fracture

This 55-year-old female had a chest X-ray during a follow-up visit for the management of her breast cancer. The chest X-ray demonstrated an embolized venous catheter superimposed upon the mediastinum. It was determined that the catheter of the patient's arm port had fractured and embolized to the pulmonary circulation. The catheter was retrieved, in the interventional radiology suite, under fluoroscopic guidance. The patient suffered no ill effects. Subsequently, one day later, the old vein port was removed and a new arm port and associated catheter were implanted to facilitate the delivery of the patient's ongoing chemotherapy.

Taking the Leap From PICC Placement to Tip Placement

2007 ◽  
Vol 12 (3) ◽  
pp. 148-155 ◽  
Author(s):  
Timothy Royer ◽  
Ann Earhart
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Scope Of Practice ◽  
X Rays ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Primary Physician ◽  
Picc Line ◽  
Central Catheters

Abstract Nurses who place peripherally inserted central catheters (PICCs) obtain x-rays after placement to determine tip placement. Radiologists read and interpret the x-ray to verify tip placement. It is then the primary physician or the radiologist who releases the PICC line for use. Until 2002, there were few institutions across the United States that empowered the vascular access nurse to take on this responsibility. This article discusses how to advance practice at the state-board-of-nursing level and discusses strategies to implement the change in scope of practice.

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