title: Does a novel method of PICC insertion improve safety?
abstract: BACKGROUND
  Placing a central venous access device via the internal jugular or subclavian vein entails significant risks to both patient and healthcare worker.
  
  
  OBJECTIVE
  The purpose of this randomized, prospective study was to determine whether the accelerated Seldinger technique (AST) offers significant safety advantages over the modified Seldinger technique (MST) for peripherally inserted central catheter insertion.
  
  
  METHODS
  Patients were randomly assigned to undergo introducer sheath insertion by means of either MST or AST. Primary outcome measures included time to completion of introducer sheath insertion, estimated blood loss, and success rate. Secondary outcome measures included vessel-to-air exposure events and unprotected sharps exposure.
  
  
  CONCLUSIONS
  While both insertion methods proved equivalent for successful vessel cannulation, AST was significantly faster (P = 0.0048) and resulted in less blood loss (P = 0.0295) than MST. Additionally, AST resulted in significantly fewer vessel-to-air exposure events (P < 0.0001) and unprotected sharps exposures (P < 0.0001). Although this was a relatively small and unblinded study, the high degree of statistical significance of the study results suggests that, for both patients and healthcare workers, AST is faster and safer than MST for PICC peelable introducer sheath insertion.
authors.affiliation: In the infection control department at New York Hospital Queens in Flushing, N.Y., Jona Caparas is the IV/PICC team coordinator and Jian Ping Hu and Hwei-San Hung are PICC nurses. Ms. Caparas is also the president of the Association for Vascular Access New York Metro Network.
authors.forename: Jona
authors.initials: J
authors.lastname: Caparas
authors.forename: Jian Ping
authors.initials: JP
authors.lastname: Hu
authors.forename: Hwei-San
authors.initials: HS
authors.lastname: Hung
mesh_terms: D002405:Catheterization, Central Venous / Q000379:methods* / Q000451:nursing; D002406:Catheterization, Peripheral / Q000379:methods* / Q000451:nursing; D006801:Humans; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D061214:Patient Safety / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016896:Treatment Outcome