Optimised two-stage technique for sheath-dilator insertion in peripherally inserted central catheter placement

Peripherally inserted central catheters (PICCs) provide a valuable alternative to traditional central venous access, offering smaller-diameter lines and supporting prolonged infusion therapy. Although recent advancements have addressed many of the initial challenges of PICC insertion, some catheter-related complications remain significant. In cases of mechanical complications, shearing of the peel-away sheath typically occurs while inserting the sheath-dilator, necessitating further dermatotomy and thereby increasing patient morbidity.

The alternative technique involved disassembling the sheath-dilator apparatus into its individual components: the peel-away sheath and introducer dilator. After successfully advancing the guidewire through the needle, the dilator alone was inserted over the guidewire and then removed. Subsequently, the dilator and sheath were reassembled and inserted simultaneously through the skin. The study included four patients (mean age, 55.75 (range: 26-78) years), all of whom underwent PICC placement using the proposed method.

Advanced dilator insertion effectively prevented sheath shearing and facilitated successful PICC placement on the first attempt in all patients. No haematomas or catheter-related complications were observed.

Using the alternative technique, a high success rate of first-attempt PICC insertions was achieved. This approach may reduce the need for additional dermatotomy, thus minimising patient morbidity and improving procedural outcomes.