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Interventional radiologic placement of peripherally inserted central catheters
J F Cardella1, P S Fox, J B Lawler
1Department of Radiology, Penn State University College of Medicine, Milton S Hershey Medical Center, Hershey 17033.
Journal of Vascular and Interventional Radiology : JVIR
|September 1, 1993
Summary
Fluoroscopic guidance significantly improves peripherally inserted central catheter (PICC) placement success compared to bedside insertions. This method ensures nearly all patients can receive necessary central venous access, even with difficult venous anatomy.
Area of Science:
- Vascular Access Procedures
- Interventional Radiology
- Medical Device Placement
Background:
- Peripherally inserted central catheters (PICCs) are crucial for intermediate and long-term venous access.
- Assessing the efficacy of different insertion techniques is vital for patient care.
- Bedside and fluoroscopic-assisted methods present distinct success rates and complication profiles.
Purpose of the Study:
- To compare the success rates of bedside PICC insertions by clinicians versus fluoroscopically assisted insertions by interventional radiologists.
- To evaluate the impact of insertion technique on overall patient outcomes and device dwell time.
Main Methods:
- A study involving 305 patients requiring central venous access.
- Comparison of 150 bedside PICC insertions against 155 fluoroscopically assisted PICC insertions.
- Analysis of dual- and single-lumen PICC device usage based on patient needs.
Main Results:
- Fluoroscopic insertion achieved a significantly higher success rate (98.7%) compared to bedside insertion (74%).
- Average PICC dwell time was 72.7 days, with most patients (73.4%) completing therapy with a single catheter.
- Complications included thrombophlebitis and infection, with higher rates reported for bedside insertions.
Conclusions:
- Fluoroscopic guidance by interventional radiologists offers superior PICC placement success.
- This technique facilitates PICC insertion in nearly all patients, including those with challenging venous access.
- Fluoroscopically placed PICCs demonstrate favorable outcomes comparable to surgically placed central catheters.