A randomized, controlled trial evaluating postinsertion neck ultrasound in peripherally inserted central catheter...

Area of Science:

• Vascular Access Procedures
• Medical Imaging
• Patient Safety

Background:

• Peripherally inserted central catheters (PICCs) are widely used for long-term venous access.
• PICC insertion at the bedside can lead to catheter tip malposition, potentially causing complications.
• Identifying malposition early is crucial for patient safety and procedural efficiency.

Purpose of the Study:

• To evaluate the effectiveness of adding ultrasound (US) inspection of the ipsilateral neck during bedside PICC placement.
• To determine if US guidance can facilitate immediate recognition and correction of PICC tip malposition in the internal jugular vein (IJ).

Main Methods:

• A randomized controlled trial involving 300 patients undergoing PICC placement.
• Patients were randomized to either postinsertion US neck inspection (intervention group) or usual practice (control group).
• The intervention group utilized US to detect and correct PICCs malpositioned in the IJ before procedure completion.

Main Results:

• The rate of PICC tip malposition in the ipsilateral IJ was significantly reduced in the intervention group (0.7%) compared to the control group (7.9%).
• Ultrasound successfully guided repositioning in 11 intervention procedures, preventing malposition.
• Procedure duration showed a minimal increase in the intervention group (median 9.0 minutes) versus the control group (median 8 minutes).

Conclusions:

• Ultrasound inspection of the ipsilateral neck is an effective method to reduce PICC tip malposition during bedside insertion.
• This technique allows for immediate catheter repositioning, enhancing patient safety and reducing PICC-related morbidity.
• US guidance during PICC placement is a valuable tool for improving procedural outcomes.