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Learning Objective 1: describe the results of using upper arm placement of peripherally inserted catheters (PICCs) utilizing bedside ultrasound and microintroducer technique.
Learning Objective 2: apply the findings of using PICCs with bedside ultrasound and microintroducer technique to improve quality health care in practice and education.
The performance of placing this device is significantly improved by utilizing the microintroducer technique, also known as the Modified Seldinger Technique (MST), coupled with venous ultrasound (US) technology. To date, there is a scarcity of nursing literature reporting increased success rates of PICC placement, and resulting decreases in complications when these advanced modalities are applied.
The purpose of this study was three-fold for analyzing and reporting outcome data specific to upper arm placement of 6-French dual-lumen and triple-lumen, power-injectable PICCs. These data included the occurrence of mechanical phlebitis, occurrence of infection associated with PICCs that have dwelled in situ, and the placement success rates of PICCs inserted by designated, specialty registered nurses.
This study analyzed archival data from a nursing database in one hospital in southern Georgia in which outcome results had been recorded on PICCs placed in situ. The review and analysis of 500 PICC procedural attempts inserted by designated, specialty nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. This analysis also provided information on the disposition of those catheters actually placed in situ on subjects who remained hospitalized or within the hospital’s rehabilitation facility. Of the 422 catheters removed, none of these subjects exhibited signs or symptoms of mechanical phlebitis, and one tested positive per laboratory analysis for organisms confirming infection.
It is imperative for nurses to conduct research studies that solidify and validate the positive outcomes of advanced modalities for PICC placement, thus promoting this vascular access technology as the gold standard of care. The findings of this study should serve as a catalyst for future nursing research on the effective advantages of microintroducer technique coupled with portable venous ultrasound at bedside. It is, therefore, desirable for findings of this study to be disseminated among professional nursing publications and organizations.
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