Placement of peripherally inserted central catheters in children guided by ultrasound: a prospective randomized, and controlled trial

OBJECTIVE

To compare the use of vascular Doppler ultrasound with vein visualization and palpation for positioning peripherally inserted central catheters in children and to determine the influence of these methods on the success of the first puncture attempt, catheter positioning, and time required for the accomplishment.

DESIGN

A prospective randomized, controlled trial was conducted in a university hospital after ethical approval and was carried out among children (from birth to 18 yrs).

SETTING

São Paulo Hospital, São Paulo, Brazil.

PATIENTS

The sample comprises 42 peripherally inserted central catheters insertions allocated randomly into two groups: 1) an ultrasound group with 21 peripherally inserted central catheters guided by ultrasound; and 2) a control group with 21 catheters, in which the peripherally inserted central catheters were inserted using vein visualization and palpation.

INTERVENTIONS

The procedure was performed by two trained nurses using a standard protocol for peripherally inserted central catheter insertion and ultrasound use. Ultrasound group equipment was ILook25 (Sonosite, Bothell, WA) with a 25-mm, 10- to 15-MHz linear array transducer that reaches a 4-cm depth.

MEASUREMENTS AND MAIN RESULTS

Success in the first puncture attempt was higher (p = .003) in the ultrasound group (90.5%) than in the control group (47.6%). The catheter positioning success rate was 85.7% in the ultrasound group and 52.4% in the control group (p = .019). The median time spent on the procedure for the ultrasound group was 20 mins, whereas it was 50 mins for the control group (p = .001).

CONCLUSION

The use of ultrasound increased the successful positioning of peripherally inserted central catheters in comparison with the venous anatomic landmark visualization and palpation technique and further optimized the time spent on the procedure.

The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions: final report of investigation

The risk of thrombosis related to peripherally inserted central catheters (PICCs) is a well-known complication. A study was conducted to compare thrombosis rates associated with the old technique of inserting PICCs by visualizing veins in the antecubital fossa, using anatomical landmarks and palpation versus using ultrasound guidance to locate veins in the upper arm. The findings from data collected on 538 patients included a significant decline in the thrombosis rates, as thrombosis decreased from 9.3% with the palpation method to 1.9% with the ultrasound method, and successful PICC placements by registered nurses increased from 76.9% when using the old method to 98.9% when using ultrasound guidance.