Abstract
OBJECTIVE: A peripherally inserted central catheter (PICC) provides effective central venous access without serious mechanical complications. Several specific problems, however, have been reported, including malpositioning of the catheter tip, thrombophlebitis, and difficult venous access. Although the use of fluoroscopic guidance during insertion is recommended to avoid tip malpositioning, the transfer of patients to the radiology suite and radiation exposure can sometimes be problematic. We, therefore, extensively utilized ultrasound at the bedside during venous puncture and localization of the tip without using fluoroscopy to address these issues.
METHODS: A total of 116 adult inpatients underwent PICC placement in wards. PICCs were inserted through peripheral veins of an upper arm under ultrasound guidance. Then, images of the catheter in the ipsilateral axillary vein and internal jugular vein were detected by ultrasound. If malpositioning to the internal jugular vein was recognized, the tip position was adjusted before procedural completion. After completing catheter placement, all patients underwent chest radiography to assess the catheter tip position.
RESULTS: Venous puncture was successful in 115 patients (99%). Catheter insertion was successful in 111 patients (95.7%). In 4 patients (3.4%), the catheters could not be threaded due to stenosis of the subclavian vein.
CONCLUSION: Using ultrasound during venous puncture and catheter tip localization, PICC can be placed with marked accuracy.
