Nurse-Performed Ultrasound-Guided Peripherally Inserted Central Catheter (PICC) Placement During General Anesthesia: A Retrospective Cohort Study

TL;DR

This study shows that nurse-led PICC placement during surgery is faster and lasts longer than traditional CVCs, with similar safety.

Contribution

Demonstrates the feasibility and efficiency of nurse-performed PICC placement under general anesthesia compared to CVCs.

Findings

PICC placement time was significantly shorter than CVC placement time.

PICC dwell time was longer than CVC dwell time.

CRBSI incidence was not significantly different between PICC and CVC groups.

Abstract

Background: Central venous access is essential in perioperative management of major abdominal surgery. While centrally inserted central venous catheters (CVCs) are widely used, insertion-related mechanical complications remain a concern. Peripherally inserted central catheters (PICCs) may represent an alternative strategy, particularly when integrated into nurse-led task-sharing workflows. This study evaluated the feasibility and procedural outcomes of ultrasound-guided PICC placement during general anesthesia.

Methods: This single-center retrospective observational study included 86 adult patients undergoing gastrointestinal surgery under general anesthesia who required central venous access between January 2023 and December 2025. Patients were divided into a PICC group (n = 41) and a CVC group (n = 45). The primary outcome was catheter placement time (minutes). Secondary outcomes included catheter dwell time (days), catheter-related bloodstream infection (CRBSI), and catheter occlusion with intraluminal thrombus. CRBSI was assessed in accordance with CDC guidance, and patients were followed until catheter removal.

Results: Baseline characteristics were comparable between groups. Catheter placement time was significantly shorter in the PICC group than in the CVC group (5.5 ± 3.1 vs. 7.0 ± 2.3 minutes, p = 0.013). Catheter dwell time was longer in the PICC group (7.1 ± 3.1 vs. 3.3 ± 1.7 days, p < 0.001). CRBSI incidence did not significantly differ between groups (2.4% vs. 8.9%, p = 0.363). Catheter occlusion with intraluminal thrombus occurred in one patient (2.4%) in the PICC group and in none in the CVC group. All catheter placements were successful (100% in both groups).

Conclusions: Ultrasound-guided PICC placement during general anesthesia was associated with shorter catheter placement time and longer catheter duration than CVC placement in this retrospective cohort. Catheter-related complications were infrequent; however, definitive conclusions regarding comparative safety are limited by the observational design and low event counts. These findings support the feasibility of perioperative PICC use and suggest potential workflow implications within structured nurse-led task-sharing models. Further prospective multicenter studies incorporating direct operating room workflow metrics and catheter-day-based outcomes are warranted.

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