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

Affiliations
  • 1Department of Neurology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
  • 2Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  • 3Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  • 4Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

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
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