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Cumulative experience with 1,273 peripherally inserted central catheters at a single institution
J F Cardella1, K Cardella, N Bacci
1Department of Radiology, Pennsylvania State University Hospital, Hershey 17033, USA.
Journal of Vascular and Interventional Radiology : JVIR
|January 1, 1996
Summary
Specially-trained nurses provide cost-effective bedside insertion of peripherally inserted central catheters (PICCs). However, interventional radiologists remain essential for complex cases and device salvage.
Area of Science:
- Vascular Access Procedures
- Medical Device Insertion
- Nursing Practice
Background:
- Peripherally inserted central catheters (PICCs) are crucial for long-term intravenous therapy.
- Optimizing PICC insertion methods is vital for patient care and resource management.
Purpose of the Study:
- To compare the efficacy and outcomes of bedside PICC insertion by specially-trained nurses versus cardiovascular and interventional radiologists.
- To evaluate technical success rates, complications, and cost-effectiveness of different PICC insertion approaches.
Main Methods:
- Nurses performed 327 bedside insertions using a palpatory, through-the-needle technique.
- Radiologists performed 542 insertions using a venographic-fluoroscopic direct puncture and sheath technique.
- A total of 869 PICCs were inserted in 655 patients across both groups.
Main Results:
- Bedside nurse-led technical success improved from 74% to 82.6% over the study period.
- Overall technical success rates were high (98.2% for radiologists, 82.6% for nurses).
- Complication rates (thrombophlebitis, infection) remained low, but device failure and the need for multiple PICC insertions were noted.
Conclusions:
- Bedside PICC insertion by trained nurses offers a less costly alternative to radiologist insertion.
- Interventional radiologists are indispensable for managing difficult insertions, PICC salvage, and exchanges.
- A hybrid approach may optimize patient care and resource utilization for PICC placement.