Faced with the risk of medical complications and the high costs that the insertion of Central Venous Catheters (CVCs) represents for health systems, ultrasound-guided Peripherally Inserted Central Catheters (PICCs) are currently the safest, most efficient and innovative option for critical, surgical and certain patients chronic diseases.
CVCs are devices 20 to 30 centimeters in length that are usually inserted from the subclavian or internal jugular vein through a procedure performed by a physician in an intensive care unit or operating room.
Risks that may occur
The most common complications are arterial puncture, bruises, catheter-related bloodstream infections, hemothorax/pneumothorax, arrhythmias, and neurological injury. They occur in up to 19% of patients, prolonging their hospital stay between seven and 12 days. In the end, this generates an increase in care expenses.
Although there are no precise data for Mexico, in the United States (according to publications from the Center for Disease Control and Prevention) each year there are 250,000 cases of bacterial bloodstream infection (CRBSI) associated with the placement of CVCs.
Faced with this scenario, PICCs assisted with systems for monitoring and confirming the tip of the catheter through ultrasound are a cutting-edge, efficient and safe solution for the patient. At the same time they help optimize hospital resources.
What does this alternative consist of?
These devices combine the benefits of PICCs with the efficiency of contrast media injection. They are indicated for infusion therapy greater than seven days and less than 12 months; for the administration of drugs and solutions, parenteral nutrition, chemotherapy, antibiotic therapy and hematopoietic stem cell infusion therapies.
“There is enough evidence in the medical literature and in clinical practice to affirm that PICCs are a good alternative to CVCs. They provide safety, ease of placement, comfort and innovation that translate into better monitoring and quality of life for chronic, critical and cancer patients. In addition, they facilitate and simplify sample collection for laboratory personnel”, said Dr. Gabriel Adrián García Correa, Clinical and Consulting Manager of BD México.
On the other hand, some PICCs are placed using the portable ultrasound-guided Modified Seldinger technique, which allows verifying the existence of an appropriately sized vein before performing the venipuncture. This increases the success rate of catheter insertion on the first attempt, decreases the risk of multiple punctures and minimizes the risk of adverse events such as pneumothorax, hemothorax and infections, while offering greater comfort and safety for the patient.
“Some ultrasound-guided PICCs use real-time tracking technology to visualize the direction and orientation of the catheter tip, increasing positioning efficiency and reducing mispositions. This system is an alternative to chest radiography and fluoroscopy to confirm PICC tip placement in adult patients; minimizes patient exposure to X-ray radiation,” added María de Lourdes Meléndez Sotelo, manager of Medical Affairs at BD Mexico.
He added that these innovative PICCs -unlike CVCs- can be placed by previously trained nursing staff, which can have a significant positive impact on optimizing the hospital’s infrastructure and human and financial resources.
Finally, health experts called on the medical community and nursing staff to learn about the advantages of ultrasound-guided PICCs over conventional CVCs.