Fluoroscopically guided repositioning of peripherally inserted central catheter in patients failing ultrasound-guided-only placement: a retrospective five-year study

The difficult PICC insertion is associated with the significant increase of complications in 1 month follow-up

BACKGROUND

PICC is routinely inserted with assistance of ultrasonography and/or ECG navigation (RI- routine insertion). Only in a minority of patients the insertion of a PICC is difficult and fluoroscopic visualization with introduction of special guidewire is necessary for the success of the procedure (DI-difficult insertion). The aim of the study was to evaluate whether DI can be predicted and associated with a risk of complications during follow-up.

METHODS

The study included patients who had a PICC insertion in 2022. The number of patients with RI and DI was recorded and the significance of selected parameters during insertion and the frequency of complications during 1 month follow-up was compared.

RESULTS

About 1404 patients had successful PICC insertion in 2022, RI in 1360 (96.8%) and DI in 44 patients (3.2%). There was no significant effect of age, gender, selected vein, its size, insertion site, and tunneling on the course of PICC insertion. However the number of punctures for needle insertion was higher in DI. The complication rate during 1 month follow-up in DI was 9 (20.4%) versus 101 patients (7.4%) in RI (p = 0.002).

CONCLUSION

PICC insertion was successful in both RI and DI patients. Of the analyzed parameters, the number of needle punctures was associated with DI, and complications during the 1-month follow-up were more frequently noted in the DI group.

Precision at the Bedside: Practical Efficacy of Clockwise Catheter Torque for Accurate Tip Positioning of Peripherally Inserted Central Catheters

Precise placement of peripherally inserted central catheters (PICCs) is essential for avoiding treatment risks and ensuring the success of treatment. This is typically performed under imaging guidance, but imaging modalities may not be accessible under resource-limited settings or alternative settings such as communicable disease isolation rooms. Here, we have proposed a new technique for the precise placement of PICCs through the application of clockwise torque. Application of the PICC with this technique in our patient resulted in the precise insertion of the catheter. As this method eliminates the need for imaging modalities, it has promise for application at the bedside and in resource-limited settings. Importantly, it presents a new aspect of catheterization protocols that could hold immense potential for the future. In the future, its efficiency needs to be verified in a larger number of patients under different settings and from different populations.