A Single-Center Experience of Fluoroscopic-Guided Peripherally Inserted Central Catheter Insertion by Nursing Staff: Rationale and Clinical Outcomes

Medical staff traditionally perform most peripherally inserted central catheters (PICCs) insertions in our tertiary Australian center. Centers that run ward-based PICC services have higher malposition and reattempt rates than fluoroscopy-guided insertion. Patients with repeated line requirement and preexisting central venous stenosis or occlusion make these technical difficulties more difficult to overcome without fluoroscopy. A fluoroscopy-guided PICC insertion service by nonmedical staff such as nursing staff may be a viable alternative to the current model of care. Practical and theoretical PICC insertion training was completed using a standardized in-house education package including line placement under supervision. Data were collected on the first 50 unsupervised nurse–inserted PICC lines to assess insertion success, line tip positioning, and long-term outcomes. In the 50 patients assessed, there was 100% insertion success and 0% malposition. There were no insertion complications and a long-term complication rate of 5.12 complications per 1000 catheter-days, which is comparable to existing literature. Complication rates were either at or below expected ranges described in literature, and malposition was significantly lower when inserted under fluoroscopy guidance than prior literature for ward-based services. We propose that a fluoroscopy-guided PICC service performed by nursing staff will be cost-effective and have flow-on effects to improve radiology team productivity and ward access, with similar clinical line outcomes to medical staff insertions.