![]() Therefore, the objective of this study was to investigate the safety and feasibility of ultrasound-guided PICC by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and CCVC. However, there is limited data on the safety and feasibility of ultrasound-guided PICC performed by neurointensivists in the neurosurgery ICU compared to fluoroscopy-guided PICC or conventional central venous catheter (CCVC). It has been also performed by intensivists at the bedside for critically ill patients who were transport risks. Recently, ultrasound-guided PICC has been performed by vascular access teams. However, critically ill patients can experience adverse events during transport if they have respiratory failure or hemodynamic instability. ![]() Traditionally, PICC placement has been performed by interventional radiologists in the interventional radiology suite under fluoroscopic guidance. Therefore, the use of PICC has many theoretical advantages in the neuroscience ICU setting due to the low risk of complications. PICCs have been increasingly utilized because of easy placement and a lower rate of insertion-related mechanical complications, venous thrombosis, and infection. Peripherally-inserted central venous catheters (PICC) have been widely used for central venous access for long-term intravenous therapy. Neurocritically ill patients and neurosurgery patients often require access to the central vein during their intensive care unit (ICU) stay. Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups ( p = 0.038). There was no significant difference in procedure time between the three groups. However, all re-inserted central lines were successful. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside ( p = 0.004). The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation ( p = 0.001) and with hemodynamic instability ( p <0.001) compared to the fluoroscopy-guided PICC placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. ![]() Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. The secondary endpoint was initial success of central line placement. In this study, the primary endpoint was central line-induced complications. This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC).
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