Peripherally Inserted Central Catheter (PICC) Insertion Success and Optimal Placement with New Technology: A Pre-Post Cohort Study

Background: Peripherally inserted central catheters (PICCs) are commonly placed with the assistance of fluoroscopy or medical imaging, ultrasound, electrocardiogram guidance, or all the above. Innovative ultrasound technologies continue to emerge; however, the impact upon clinical outcomes is not well understood. In this study, we aimed to compare outcomes of an existing ultrasound system with SHERLOCK 3CG™ Tip Confirmation (preintervention) to an updated SHERLOCK 3CG Diamond Tip Confirmation system, incorporating catheter-to-vein ratio measurement capabilities and an advanced magnetic-based tip navigation system (postintervention). Methods: In this prospective pre-post cohort study, we recruited adult patients requiring a new PICC. The study was conducted at a quaternary hospital in Queensland, Australia. Data were collected between May 2017 (4 months before equipment introduction) and January 2018 (4 months after equipment introduction), with a 1-month exclusion (education or learning) period in between. Patient, PICC, and device removal details were collected. The primary outcome was first-time insertion success, defined as successful PICC insertion after a single attempt (skin puncture), with the tip confirmed in an optimal location by the navigation system and a subsequent chest x-ray (as per hospital policy). Results: There were 503 participants with patient demographics and PICC characteristics balanced between the preintervention (n = 266) and postintervention (n = 237) groups. First-time insertion success was higher in the preintervention group (203/255, 80%) than the postintervention group (166/226, 73%), but this was not statistically significant (risk ratio = 0.92, 95% confidence interval = 0.83–1.02). Conclusions: There was no change in clinical outcomes with the use of next-generation ultrasound technology. These results justify future large studies and subsequent review into the efficacy of tip-confirmation systems and processes to maintain patient safety.