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- Title
Peripherally Inserted Central Catheter (PICC) Insertion Success and Optimal Placement with New Technology: A Pre-Post Cohort Study.
- Authors
Nicholas, Megan; Larsen, Emily N.; Rickard, Claire M.; Mihala, Gabor; Groom, Peter; Marsh, Nicole
- Abstract
Background: Peripherally inserted central catheters (PICCs) are commonly placed with the assistance of fluoroscopy or medical imaging, ultrasound, electrocardiogram guidance, or all the above. Innovative ultrasound technologies continue to emerge; however, the impact upon clinical outcomes is not well understood. In this study, we aimed to compare outcomes of an existing ultrasound system with SHERLOCK 3CG™ Tip Confirmation (preintervention) to an updated SHERLOCK 3CG Diamond Tip Confirmation system, incorporating catheter-tovein ratio measurement capabilities and an advanced magnetic-based tip navigation system (postintervention). Methods: In this prospective pre-post cohort study, we recruited adult patients requiring a new PICC. The study was conducted at a quaternary hospital in Queensland, Australia. Data were collected between May 2017 (4 months before equipment introduction) and January 2018 (4 months after equipment introduction), with a 1-month exclusion (education or learning) period in between. Patient, PICC, and device removal details were collected. The primary outcome was first-time insertion success, defined as successful PICC insertion after a single attempt (skin puncture), with the tip confirmed in an optimal location by the navigation system and a subsequent chest x-ray (as per hospital policy). Results: There were 503 participants with patient demographics and PICC characteristics balanced between the preintervention (n = 266) and postintervention (n = 237) groups. First-time insertion success was higher in the preintervention group (203/255, 80%) than the postintervention group (166/226, 73%), but this was not statistically significant (risk ratio = 0.92, 95% confidence interval = 0.83-1.02). Conclusions: There was no change in clinical outcomes with the use of next-generation ultrasound technology. These results justify future large studies and subsequent review into the efficacy of tip-confirmation systems and processes to maintain patient safety.
- Subjects
QUEENSLAND; HOSPITALS; PERIPHERAL central venous catheterization; CONFIDENCE intervals; ULTRASONIC imaging; MEDICAL device removal; PERIPHERALLY inserted central catheters; MEDICAL technology; PRE-tests &; post-tests; QUALITY assurance; LONGITUDINAL method
- Publication
Journal of the Association for Vascular Access, 2021, Vol 26, Issue 1, p39
- ISSN
1552-8855
- Publication type
Article
- DOI
10.2309/JAVA-D-20-00030