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Supraclavicular ultrasonographic real-time guidance for PICC insertion

"Supraclavicular ultrasonographic real-time guidance for peripherally inserted central catheter placement was feasible and enabled successful placement" Kirkegaard et al (2021).

Abstract:

Background: Mispositioning is common during insertion of peripherally inserted central catheters. Ultrasonographic visualisation of anatomical structures may enable continuous guidance during insertion. The aim was to investigate the feasibility of ultrasonographic real-time guidance of peripherally inserted central catheter placement using the supraclavicular fossa view.

Methods: An observational quality control study was performed including 20 patients. Ultrasonography was performed via the right supraclavicular fossa using a microconvex probe identifying the junction between the right internal jugular- and the subclavian vein forming the right brachiocephalic vein. The wire guide tip was identified at the junction allowing estimation of catheter length. The catheter stiffening wire was followed in real-time into the right brachiocephalic vein towards the superior vena cava. Mispositions and the ability to redirect in real-time were detected. Final catheter tip positions were evaluated by either fluoroscopy or a chest radiograph.

Results: Catheters were successfully placed in 19/20 patients. In all patients the junction and the right brachiocephalic vein was identified. Two thrombi were identified in the right brachiocephalic vein and left-sided insertions were performed. In 16 out of 17 right-sided insertions, wire guide and catheter stiffening wire were visible. Of the 16 visual catheters, 15 could be followed into the right brachiocephalic vein. Real-time mispositioning was identified in eight cases and optimal redirection was successful in seven. All ultrasound-guided catheter length estimations were adequate.

Conclusions: Supraclavicular ultrasonographic real-time guidance for peripherally inserted central catheter placement was feasible and enabled successful placement together with detection and redirection of mispositioned catheters without delay.

Reference:

Kirkegaard E, Lind PC, Dolmer H, Juhl-Olsen P. Supraclavicular ultrasonographic real-time guidance of peripherally inserted central catheters – a feasibility study. Acta Anaesthesiol Scand. 2021 Jan 16. doi: 10.1111/aas.13782. Epub ahead of print. PMID: 33454952.