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

Area of Science:

• Vascular Access Devices
• Minimally Invasive Procedures
• Patient Safety

Background:

• Peripherally inserted central catheters (PICCs) are crucial for prolonged infusion therapy but face complications.
• Mechanical issues during PICC insertion, particularly sheath shearing, can increase patient morbidity due to additional procedures.
• Existing advancements haven't fully resolved all catheter-related complications.

Purpose of the Study:

• To introduce and evaluate an alternative technique for PICC insertion.
• To mitigate mechanical complications, specifically peel-away sheath shearing.
• To enhance procedural success rates and patient outcomes.

Main Methods:

• A modified technique involved disassembling the sheath-dilator apparatus.
• The dilator was inserted alone over the guidewire before sheath reassembly and simultaneous insertion.
• The technique was applied to four patients undergoing PICC placement.

Main Results:

• The advanced dilator insertion technique successfully prevented sheath shearing in all cases.
• All patients achieved successful PICC placement on the first attempt.
• No instances of haematoma or catheter-related complications were reported.

Conclusions:

• The alternative PICC insertion technique demonstrates a high success rate for first-attempt placements.
• This method has the potential to reduce the need for further dermatotomy, thereby minimizing patient morbidity.
• The improved approach offers better procedural outcomes in PICC line insertion.