Enhancing autonomy in PICC placement: The feasibility of single-operator bubble test technique

Area of Science:

• Medical Imaging
• Interventional Cardiology
• Vascular Access

Background:

• Accurate peripherally inserted central catheter (PICC) tip positioning is crucial for function and complication avoidance.
• Intracavitary electrocardiography (IC-ECG) is standard but has limitations.
• The traditional two-operator ultrasound bubble test (CEUS) can be inefficient.

Purpose of the Study:

• To introduce and evaluate a novel single-operator bubble test for PICC tip confirmation.
• To assess the feasibility and reproducibility of this streamlined technique.

Main Methods:

• A single operator performed agitated saline injection and ultrasound assessment using a convex probe manipulated externally through sterile drapes.
• Utilized a single ultrasound system with both linear and convex probes for subcostal cardiac views.
• A preliminary descriptive case series of 10 adult patients was conducted.

Main Results:

• The single-operator technique was feasible and reproducible in all 10 patients.
• Successful real-time visualization of microbubbles in the right atrium was achieved.
• No immediate procedure-related complications were reported.

Conclusions:

• The single-operator bubble test enhances procedural autonomy and efficiency for PICC tip confirmation.
• It offers a practical, safe, and radiation-free alternative, especially in resource-limited environments.
• Requires advanced ultrasound skills and careful infection control measures.