A randomised, controlled trial comparing the long-term effects of peripherally inserted central catheter placement in chemotherapy patients using B-mode ultrasound with modified Seldinger technique versus blind puncture

摘要

Objective: To compare the effects of peripherally inserted central venous catheter (PICC) placement using B-mode ultrasound with the modified Seldinger technique (BUMST) versus the blind puncture. Methods: One hundred chemotherapy patients were recruited to participate in a randomised, controlled trial in Guangzhou, China. Fifty were assigned to the experimental group (using BUMST), and 50 were assigned to the control group (blind puncture). Demographic and background data, data related to PICC placement, complications after PICC placement, the patients' degree of comfort (determined via a questionnaire), and patients' costs for PICC maintenance were collected to compare the effects of the two methods. T-tests and chi-square tests were used to analyse the data; p<0.05 was accepted as statistically significant. Results: Nighty-eight of the 100 PICCs were successfully inserted (50 in the experimental group and 48 in the control group). Compared with the control group, the experimental group had a lower rate of unplanned catheter removal (4.0% vs. 18.7%; p=0.02), a lower incidence of mechanical phlebitis (0% vs. 22.9%; p<0.001), a lower incidence of venous thrombosis (0% vs. 8.3%; p=0.037), and a higher incidence of catheter migration (32% vs. 2.1%; p<0.001). Compared with the control group, the experimental group experienced significantly less severe contact dermatitis (p=0.038), had improved comfort at 1 week, 1 month, 2 months, and 3 months after PICC placement (p<0.001), and had lower costs for PICC maintenance at 2 months, 3 months and when the catheter was removed (p<0.05). Conclusions: Using B-mode ultrasound with MST for PICC placement reduced complications and patients' costs for PICC maintenance and improved patients' degree of comfort; thus, this procedure should be more widely used. The clinical trial registration number: ChiCTR-TRC-12002749.