A single institution experience of seven hundred consecutively placed peripherally inserted central venous catheters.

Abstract

Peripherally inserted central venous catheters (PICCs) are being increasingly placed at the bedside by trained vascular access professional such as nurses. This is to increase the availability of the service, for cost containment, and to reduce the workload on the interventional radiologist. We describe a single institution experience with over 700 PICC lines placed by trained nurses at the bedside and determine the success rate, malposition rate of the PICC line , degree of support needed from the Interventional radiologist, and factors affecting a successful placement of a PICC line by the nurses. Seven hundred and five PICC lines were placed at the South Nassau Communities hospital between July 2011 and November 2012 by trained vascular access nurses with interventional radiology backup. Bedside ultrasound was used for venous access, an electromagnetic catheter tip detection device was used to navigate the catheter into the desired central vein and catheter tip position was confirmed using a portable bedside chest X-ray. The nurses, with a malposition rate of 3.8%, successfully placed 91.6% (646/705) catheters. Interventional radiology support was needed for 59 cases (8.4%) and 17 cases (2.4%) for failed placement and catheter malposition adjustment, respectively. Risk factor such as presence of pacemaker wires and multiple attempts at insertion were factors predictive of an unsuccessful placement of a PICC line by the nurses. Bedside placement of PICC line by trained vascular nurses is an effective method with a high success rate, low malposition rate and requires minimal support from interventional radiology.