Bleeding outcomes of a modified two-stage sheath-dilator technique for peripherally inserted central catheter placement in ICU patients: A retrospective cohort study.

Background: Mechanical complications remain common with the placement of peripherally inserted central catheters (PICCs), particularly in critically ill patients. Given the need to minimise procedural complications, strategies for reducing bleeding during PICC placement are essential. This study evaluated the efficacy of a previously introduced two-stage technique in minimising insertion-related bleeding compared with the traditional modified Seldinger technique in ICU patients.

Methods: This study included 86 patients who underwent 92 PICC placements in the ICU of a tertiary university medical centre, between August 2022 and January 2025. Bleeding outcomes were assessed at three time points: 5 min, 30 min and within 24 h after insertion. Blood loss was evaluated semi-quantitatively based on the extent of gauze pad contamination.

Results: In total, 56 were performed using the two-stage technique and 36 using the traditional method. Baseline characteristics were comparable between the two groups. Bleeding incidence was significantly lower in the two-stage group at all time points. At 5 min post-insertion, 93% of the patients in the two-stage group had no visible or only minimal bleeding compared to 28% in the traditional group. At 30 min, 84% had no visible or only minimal bleeding compared with 14% (p < 0.001). In multivariate analysis, the two-stage technique was independently associated with a reduced bleeding risk (OR, 0.019; 95% CI, 0.005-0.074; p < 0.001). An interaction analysis showed that aPTT significantly modified the association between technique and bleeding (OR, 20.519; 95% CI, 1.643-255.851; p < 0.001).

Conclusions: The modified two-stage technique appears to be a feasible alternative to conventional PICC placement and was associated with reduced insertion-related bleeding in ICU patients. The technique also resulted in fewer dressing changes within 24 h, suggesting more stable haemostasis and potential improvements in ICU care quality.