Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Surg Today. 2024 May;54(5):487-495. doi: 10.1007/s00595-023-02748-z. Epub 2023 Sep 21.
As a safe and reliable alternative to central venous catheters (CVCs), peripherally inserted central catheters (PICCs) are commonly used in clinical practice. However, the insertion of PICCs by nurse practitioners (NPs), especially in Japan, has not been reported extensively. Thus, we investigated the safety and efficiency of PICC insertions by NPs.
The participants were 1322 patients who underwent PICC insertion by NPs at Fujita Health University Hospital (FNPs). The basilic vein in the brachium was the preferred vein for insertion; the brachial vein was the alternative. Patients were monitored from the time of PICC insertion until its removal. Ultrasonography-guided puncture was used for all catheter insertions, and the catheter tip was replaced into the superior vena cava under fluoroscopic imaging with maximal sterile barrier precautions. The outcomes of the PICC insertions by the FNPs were evaluated retrospectively.
Overall, 23 FNPs inserted a collective total of 1322 PICCs, which remained in place for a collective total of 23,619 catheter days. The rate of successful PICC insertion was 99% (1310 patients). The median time taken for PICC insertion was 12 min (interquartile range, 10-15 min). Intraoperative complications occurred in two patients (0.2%). The confirmed incidence of central line-associated bloodstream infection was 3.4% (45 patients), and these infections occurred on 1.9 per 1000 catheter days. The median duration of PICC placement was 15 days (range, 10-23 days).
PICC insertion by NPs is safe and a potential alternative to CVC insertion by surgeons.
经外周静脉置入中心静脉导管（PICC）作为一种安全可靠的中心静脉导管（CVC）替代物，在临床实践中得到广泛应用。然而，护士从业者（NPs），特别是在日本，插入 PICC 的情况尚未广泛报道。因此，我们研究了 NPs 插入 PICC 的安全性和效率。
参与者为在藤田保健卫生大学医院（FNPs）接受 NPs 插入 PICC 的 1322 名患者。首选贵要静脉作为插入部位；肱静脉为备选。从 PICC 插入到移除，对患者进行监测。所有导管插入均采用超声引导穿刺，在最大无菌屏障预防措施下，通过荧光透视成像将导管尖端替换到上腔静脉中。回顾性评估 FNPs 插入 PICC 的结果。
总体而言，23 名 FNPs 共插入了 1322 根 PICC，总共留置了 23619 天。PICC 插入成功率为 99%（1310 例）。PICC 插入的中位时间为 12 分钟（四分位间距，10-15 分钟）。两名患者（0.2%）术中出现并发症。确认中心静脉相关血流感染的发生率为 3.4%（45 例），每 1000 个导管日感染 1.9 例。PICC 留置的中位时间为 15 天（范围，10-23 天）。
NPs 插入 PICC 是安全的，是外科医生插入 CVC 的潜在替代方案。
