No Going Back: Advantages of Ultrasound- Guided Upper Arm PICC Placement

Background, Method and PurposeThe use of peripherally inserted central catheters (PICCs) in the UK has been steadily increasing since they were first introduced in 1995. Ultrasound-guided upper arm placement - which has become prevalent in the USA over the last few years - is gradually attracting interest amongst PICC placers in the UK. The literature shows that upper arm placement improves insertion success rate (Hockley, Hamilton, Young, Chapman, Taylor, Creed et al, 2007; Hunter, 2007; Krstenic, Brealey, Gaikwad & Maraveyas, 2008) and patient satisfaction (Polak, Anderson, Hagspiel, & Mungovan, 1998; Sansivero, 2000; McMahon, 2002). Following a switch to upper arm placement at her institution, the author examined audit data from before and after the change in practice to see if there were other measurable clinical improvements.ResultsComparison of data from a four-year period shows that upper arm placement in our patient population increased insertion success rate and line longevity, while reducing exit site infection, thrombosis and catheter migration.Implications for PracticeThis data shows that ultrasound-guided upper-arm placement improves patient outcomes. PICC placers still using the more traditional antecubital approach should consider a change in practice.