The Efficacy of Upper Arm Placement of Peripherally Inserted Central Catheters Using Bedside Ultrasound and Microintroducer Technique

Abstract

In one hospital in southern Georgia, the review and analysis of 500 peripherally inserted central catheter procedural attempts by designated, specialty nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. This research analysis also provided information on the disposition of those 6-French dual-lumen and triple-lumen, power-injectable peripherally inserted central catheters actually placed in situ on subjects who remained hospitalized or within the hospital's rehabilitation facility. Of the 422 catheters removed, none exhibited signs or symptoms of mechanical phlebitis, and one tested positive per laboratory analysis for organisms confirming infection.

International evidence-based recommendations on ultrasound-guided vascular access

“…With the introduction of ultrasound guidance and the modified Seldinger technique, it became rapidly evident that ultrasound-guided PICCs were very different from traditional PICCs [63]. Ultrasound guidance allowed PICC placement in the majority of patients, even when there were no obvious superficial veins in the antecubital area.…”

“…Insertion in this area allows ease of securement and dressing, patient comfort, low mobility and low risk of contamination. Many studies suggest that ultrasoundguided PICCs are associated with an average risk of infection significantly lower than standard central venous catheters [63]. Most of this effect seems to be related to the location of the exit site at mid-arm, which is far from airway secretions.…”

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

“…Observational studies [22,23] have shown that ultrasound guidance is superior to the traditional, free-hand technique, but this finding was not confirmed in a randomized study conducted in a small sample of patients [46], so the debate remains open. International practice guidelines [21] strongly recommend the use of ultrasound during central venous catheterization and PICC, whereas for accessing peripheral vessels, its use should be considered when difficulties are encountered.…”

“…The use of ultrasound is always advisable in these cases because it increases success rates and reduces the number of venipunctures. Some authors maintain that ultrasound-guided placement of a PICC is associated with lower infection rates than CVC insertion [21].…”

“…Ultrasound guidance is also used to obtain peripheral venous access, for catheterization of peripheral veins, and for peripheral insertion of central catheters (PICC) [21,22]. In this context, ultrasound guidance increases the success of catheterization, especially under difficult conditions (e.g., obese patients, children), and decreases the frequency of complications such as catheter-related infections and venous thrombosis.…”