Use of Peripherally Inserted Central Catheters As an Alternative to Central Catheters in Neurocritical Care Units

Abstract

Background Patients in neurological critical care units often have lengthy stays that require extended vascular access and invasive hemodynamic monitoring. The traditional approach for these patients has relied heavily on central venous and pulmonary artery catheters. The aim of this study was to evaluate peripherally inserted central catheters as an alternative to central venous catheters in neurocritical care settings. Methods Data on 35 patients who had peripherally inserted central catheters rather than central venous or pulmonary artery catheters for intravascular access and monitoring were collected from a prospective registry of neurological critical care admissions. These data were cross-referenced with information from hospital-based data registries for peripherally inserted central catheters and subarachnoid hemorrhage. Results Complete data were available on 33 patients with Hunt-Hess grade IV–V aneurysmal subarachnoid hemorrhage. Catheters remained in place a total of 649 days (mean, 19 days; range, 4–64 days). One patient (3%) had deep vein thrombosis in an upper extremity. In 2 patients, central venous pressure measured with a peripherally inserted catheter was higher than pressure measured concurrently with a central venous catheter. None of the 33 patients had a central catheter bloodstream infection or persistent insertion-related complications. Conclusions Use of peripherally inserted central catheters rather than central venous catheters or pulmonary artery catheters in the neurocritical care unit reduced procedural and infection risk without compromising patient management.

Peripherally inserted central catheter–related thrombosis rate in modern vascular access era—when insertion technique matters: A systematic review and meta-analysis

“…Eligible studies varied in size from 30 to 1758 patie nts. 34,[36][37][38][39][40][41][42][43][44][45][46][47][48][49] All studies were prospective observational studies except two, which were randomized controlled trials on safety of three different types of PICCs and handgrip exercise impact on DVT rate, respectively. 45,49 One study had been carried out over a 3-year period, but a change in practice had been adopted in the last year of observation to minimize catheter size and number of lumens in order to reduce thrombotic complications; only thrombosis rates following this change of practice were included.…”

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

“…PICCs have usually been inserted at the bedside by the vascular access team, using sterile precautions and a comprehensive prevention program [1]. For bedside insertion, ultrasound for vein localization and the modified Seldinger technique have been used, and placement was shown to be safe and feasible by use of these techniques [12,13]. In addition, PICCs were placed by a physician or experienced nurse of a specialized team in previous studies [1,4,11–13].…”

“…For bedside insertion, ultrasound for vein localization and the modified Seldinger technique have been used, and placement was shown to be safe and feasible by use of these techniques [12,13]. In addition, PICCs were placed by a physician or experienced nurse of a specialized team in previous studies [1,4,11–13]. PICC insertion at the bedside by a vascular access team or experienced physician was safe and feasible in critically ill patients [1,4,11–13].…”

“…In addition, PICCs were placed by a physician or experienced nurse of a specialized team in previous studies [1,4,11–13]. PICC insertion at the bedside by a vascular access team or experienced physician was safe and feasible in critically ill patients [1,4,11–13]. Therefore, ultrasound-guided PICC placement performed by an experienced neurointensivist may be safe and feasible in neurocritically ill patients [8].…”

“…However, critically ill patients can experience adverse events during transport if they have respiratory failure or hemodynamic instability [8–10]. Recently, ultrasound-guided PICC has been performed by vascular access teams [1,4,11–13]. It has been also performed by intensivists at the bedside for critically ill patients who were transport risks [8].…”