Y. W. Chang1, J. Park1, S. Safford1 1Virginia Tech Carilion School Of Medicine,Roanoke, VA, USA
Introduction: The use of peripherally inserted central catheters (PICCs) in adults is a safe and reliable form of vascular access. However, the placement of a PICC usually requires crude estimates and a chest x-ray (CXR) for confirmation. The ideal catheter tip location is at the cavoatrial junction, a target area 1.6-3.6 cm long in adults. A newly developed catheter has shown to accurately guide PICC placement in adults. This study examines the impact of using the ARROW VPS G4 (AVG) system for PICC placement.
Methods: We designed a retrospective cohort study of patients (≥18 years old) who received a PICC at our institution between 9/1/2012 and 6/1/2013. Patients were divided into three groups: the pretrial group had a PICC placed without the AVG, the trial group had a PICC placed with the AVG and CXR confirmation and the post-trial group required no CXR confirmation. We excluded patients who had a midline catheter placed, a non-sinus rhythm prior to PICC placement, and anyone with a pacemaker. All PICCs were placed by the PICC team of the hospital staffed by CRNAs.
Results: We enrolled 497 total patients: 196 (pretrial group), 148 (trial group) and 153 (post-trial group). First pass success rates and average procedure lengths were comparable between groups. The readjustment rate was 9.4%, 2.8% and 1.3% for the pretrial, trial and post-trial group respectively (p<0.01). Significantly, CXR confirmation after PICC placement averaged 121 minutes. If readjustment was required, final confirmation averaged 247 minutes. Financially, the post-trial group incurred a savings of $42 per PICC placement translating to a yearly savings of $28,000.
Conclusion: Our data supports the use of the AVG with PICC placement to reduce cost and line downtime in the adult population.
