Safety and feasibility of ultrasound-guided placement of peripherally inserted central catheter performed by neurointensivist in neurosurgery intensive care unit

Abstract

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation ( p = 0.001) and with hemodynamic instability ( p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside ( p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups ( p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.

Ultrasound-guided insertion of peripherally inserted central catheter after anesthetic induction in children undergoing surgery for moyamoya disease - Thirty cases report-

“…In recent studies, success rates defined as proper positioning of the PICC catheter with ultrasound-guided insertion have been reported to be about 81.2% and 94.4% [ 10 , 11 ] in adults and 83.9% [ 12 ] in children. Our success rate of 73.3% was relatively lower than these results.…”

Safety and feasibility of ultrasound-guided insertion of peripherally inserted central catheter performed by an intensive care trainee

“…The illness severity on ICU admission was estimated by the Simplified Acute Physiology Score 3 (SAPS 3) and Sequential Organ Failure Assessment (SOFA) systems. Central line-associated bloodstream infections (CLABSIs) were defined as an infection resulting from the same bacteria as confirmed by line and blood cultures [4,11,13,14]. CLABSIs were also identified in collaboration with the Infection Prevention and Control Team of Samsung Medical Center who monitors for CLABSIs [11].…”

“…Central line-associated bloodstream infections (CLABSIs) were defined as an infection resulting from the same bacteria as confirmed by line and blood cultures [4,11,13,14]. CLABSIs were also identified in collaboration with the Infection Prevention and Control Team of Samsung Medical Center who monitors for CLABSIs [11]. Compression ultrasonography and duplex Doppler were performed only when the patient had clinical signs and symptoms suggesting venous occlusion such as a swelled arm, unexplained local pain, or malfunctioned PICC [1,11].…”

“…Therefore, PICC may be implemented at the bedside by intensivists for critically ill patients who have transport risks [8]. In addition, ultrasound-guided PICC placements performed by intensivists have been gradually increasing due to its safety and ease-of-use [11].…”

Safety of Subclavian Venous Catheterization Using Anatomical Landmark Technique Versus Ultrasound-Guided Internal Jugular Central Venous Method Inserted in The Neuro-Intensive Care Unit

“…The use of ultrasound (US) has been proposed to reduce the number of CVC associated complications and to increase the safety and quality of CVC placement. Many studies have been published comparing the safety and e cacy of US-guided cannulation and landmark techniques of the same vein, either IJV or SCV [2][3][4][5][6] . To the best of our knowledge no previously data have been published evaluating the US-guided cannulation of the IJV compared to the catheterization of the SCV using landmark technique.…”