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Peripherally inserted central catheters: dependency of radiation exposure from puncture site and level of training
Martin Jonczyk1,2, Bernhard Gebauer1, Dirk Schnapauff1
11 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany.
Insights
Senior radiologists performed peripherally inserted central catheters (PICCs) faster, while left-sided venous access significantly reduced fluoroscopy time (FT). Left-sided approaches by experienced physicians offer a preferable method for PICC placement, reducing radiation exposure.
Area of Science:
- Interventional Radiology
- Medical Imaging
- Patient Safety
Background:
- Fluoroscopy times (FT) and dose area products (DAP) are critical metrics in interventional procedures.
- Training level and access site influence FT and DAP in procedures like chest port implantations.
- Previous studies indicate variability in FT and DAP based on access site and target vessel, but not consistently across all thoracic interventions.
Purpose of the Study:
- To investigate the combined impact of venous access site and radiologist training level on FT and DAP during peripherally inserted central catheters (PICCs) implantation.
- To analyze a large patient cohort to identify optimal practices for PICC procedures.
- To determine if specific approaches can reduce radiation exposure and procedure time.
Main Methods:
- Retrospective analysis of 681 consecutive peripherally inserted central catheters (PICC) implantations.
- Patients' procedures were categorized based on the radiologist's experience: junior (< 50 interventions) and senior (≥ 50 implantations).
- Statistical analysis using Mann-Whitney U and Kruskal-Wallis tests to compare fluoroscopy times (FT) and dose area products (DAP) between groups and access sites.
Main Results:
- Senior radiologists demonstrated significantly shorter fluoroscopy times (FT) (0.43 s vs. 0.53 s, P=0.041) compared to junior radiologists.
- No significant difference in dose area products (DAP) was observed between senior and junior radiologists (56.3 µGy*m² vs. 60.6 µGy*m², P=0.151).
- Left-sided venous access for PICC implantation resulted in a significant reduction in median FT by 60.9% (0.45 s vs. 1.15 s, P=0.010).
Conclusions:
- Left-sided venous access, particularly via the basilic and brachial veins, is associated with considerable dose reduction and shorter fluoroscopy times (FT).
- The combination of left-sided puncture and experienced interventional radiologists appears to be the preferable approach for peripherally inserted central catheters (PICC) placement.
- Implementing these findings can lead to improved patient safety through reduced radiation exposure during PICC procedures.
Abstract:
Background Several interventional procedures show a dependency on fluoroscopy times (FT) and level of training. Furthermore, FT and dose area products (DAP) vary depending on access site and target vessel for chest port implantations, but not for other thoracic interventions such as percutaneous coronary interventions. Purpose To evaluate the influence of the combination of venous access site and level of training on FTs and DAPs during peripherally inserted central catheters (PICC) implantations in a large cohort of patients. Material and Methods In this retrospective study, PICC implantations of 681 consecutive patients (385 women, 296 men; mean age = 55.0 ± 16.7 years) were analyzed. Two groups of junior (< 50 interventions) and senior (≥ 50 implantations) radiologists were investigated in respect to FT and DAP during PICC placement procedures. Statistical analysis included the Mann-Whitney U test and the Kruskal-Wallis test. P values < 0.05 were considered significant. Results Senior radiologists required significantly less FT (senior = 0.43 s, junior = 0.53 s, P = 0.041), but there was no significant difference in DAPs (senior = 56.3 µGy*m2, junior = 60.6 µGy*m2, P = 0.151). PICC implantations through the left side resulted in a significant reduction of the median FT by 60.9% (left = 0.45 s, right = 1.15 s, P = 0.010). Conclusion Due to considerable dose reduction, the left-sided puncture, especially via the basilic and brachial veins, performed by well-trained interventional radiologists seem to be the preferable approach for PICCs.
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