J Neurocrit Care.  2020 Jun;13(1):41-48. 10.18700/jnc.190114.

Safety and feasibility of ultrasound-guided insertion of peripherally inserted central catheter performed by an intensive care trainee

• Lee Y
• Ryu JA
• Kim YO
• Gil E
• Song YM

• KMID: 2503384
• DOI: http://doi.org/10.18700/jnc.190114

Abstract

Background
We investigated the safety and feasibility of ultrasound-guided peripherally inserted central venous catheter (PICC) placements performed by intensive care medical trainees in comparison to PICC placements performed by intensivists.
Methods
This was a retrospective and observational study of adult patients who underwent PICC placement and were admitted to the intensive care unit (ICU) between July 2013 and March 2018. Ultrasound-guided PICC was performed at the bedside by an intensivist or intensive care medical trainee if intrahospital transport was inappropriate. The primary endpoint was PICC-induced complications. The secondary endpoint was initial success of PICC.
Results
A total of 209 patients underwent PICC placement during the study period. There were no significant differences in age, sex, body mass index, comorbidities, causes of ICU admission, or severity scores between the trainee-led PICC and intensivist-led PICC groups. Difficult venous access (42.6%) and requirement for central line infusion (39.2%) were the most common reasons for PICC placement. The basilic vein (62.2%) was the most common target vein among patients who underwent PICC. There were no significant differences in complications between the two groups (P=0.473). In addition, the initial success rate and procedural time were similar between the two groups (P=0.108 and P=0.076, respectively). There were no insertional injuries and moderate or severe bleeding in patients with PICC.
Conclusion
Ultrasound-guided PICC placement by an intensive care medical trainee may be safer and more feasible compared to PICC placement by an intensivist.

Keyword

Peripherally inserted central venous catheter; Ultrasound; Intensivist; Trainee; Intensive care units

Figure

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  Figure 1. Study flow chart. PICC, peripherally inserted central catheter; ICU, intensive care unit.

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  Figure 2. (A) Target veins and procedure of the ultrasound-guided insertion of the peripherally inserted central catheter (PICC). Target veins were accessed by ultrasound. The cephalic vein is not shown in this ultrasound image. (B) The optimal length of the inserted PICC is measured from the site of insertion through the humeral head to the sternal notch, and down to the 3rd intercostal space. (C) The PICC is being inserted with the ultrasound-guided method in the intensive care unit (Eunmi Gil). (D) Finally, the PICC insertion is completed.

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  Figure 3. The procedure times of (A) intensive medical trainees and (B) intensivists according to procedure number. (A) Although the procedure times of intensive medical trainees were decreased after three or four procedures, (B) those of intensivist according to procedure number were similar.

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