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Does a novel method of PICC insertion improve safety?

Caparas, Jona MSN, RN, CRNI, VA-BC; Hu, Jian Ping BSN, BSJ, RN; Hung, Hwei-San RN, VA-BC

doi: 10.1097/01.NURSE.0000444725.83265.1d
Department: I.V. ROUNDS

Background: Placing a central venous access device via the internal jugular or subclavian vein entails significant risks to both patient and healthcare worker.

Purpose: The purpose of this randomized, prospective study was to determine whether the accelerated Seldinger technique (AST) offers significant safety advantages over the modified Seldinger technique (MST) for peripherally inserted central catheter insertion.

Materials and methods: Patients were randomly assigned to undergo introducer sheath insertion by means of either MST or AST. Primary outcome measures included time to completion of introducer sheath insertion, estimated blood loss, and success rate. Secondary outcome measures included vessel-to-air exposure events and unprotected sharps exposure.

Discussion: While both insertion methods proved equivalent for successful vessel cannulation, AST was significantly faster (P = 0.0048) and resulted in less blood loss (P = 0.0295) than MST. Additionally, AST resulted in significantly fewer vessel-to-air exposure events (P < 0.0001) and unprotected sharps exposures (P < 0.0001). Although this was a relatively small and unblinded study, the high degree of statistical significance of the study results suggests that, for both patients and healthcare workers, AST is faster and safer than MST for PICC peelable introducer sheath insertion.

In the infection control department at New York Hospital Queens in Flushing, N.Y., Jona Caparas is the IV/PICC team coordinator and Jian Ping Hu and Hwei-San Hung are PICC nurses. Ms. Caparas is also the president of the Association for Vascular Access New York Metro Network.

I.V. Rounds is coordinated by Cheryl Dumont, PhD, RN, CRNI, director of nursing research and the vascular access team at Winchester Medical Center in Winchester, Va. Dr. Dumont is also a member of the Nursing2014 editorial board.

The content in this article has received appropriate institutional review board and/or administrative approval for publication.

Jona Caparas is a paid lecturer on the advantages of POWERWAND MIDLINES. The authors and New York Hospital Queens received no direct funds for this study. PICC WANDs were provided at no cost by Access Scientific. The authors thank Agility Clinical, Inc., for its assistance with statistical analysis of the data.

The authors have disclosed that they have no other financial relationships related to this article.

© 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins.