Efficacy and Safety of Over-the-Wire Technique versus Direct Catheter Insertion Technique in Peripherally Inserted Central Venous Catheter Placement: A Randomized-Controlled Study

Abstract Purpose To assess the effectiveness and safety of the over-the-wire (OTW) technique as compared to the direct catheter insertion (DCI) technique in ultrasound (US) guided peripherally inserted central venous catheter (PICC) placement with fluoroscopic catheter tip location.Methods In a non-inferiority randomized-controlled study, 60 PICCs were implanted by an interventional radiologist into the basilic, cephalic, or brachial vein of the mid-upper arm. The effectiveness as primary endpoint was measured by implantation time. Placement accuracy was detected as secondary endpoint by tip location under chest x-ray, whereas safety was measured by the rate of periprocedural and early complications occurring within two weeks. Results Implantation time of 8.34 ± 2.14 minutes applying the OTW technique showed to be significantly more time-consuming than DCI technique with 5.530.96 minutes (p<0.001). The results for the secondary endpoints were not allowing a statistically significant statement due to the patient number. The exploratory analysis showed however no significant difference (p=0.3) regarding tip placement accuracy between both insertion techniques (optimal tip localization of 100% with the DCI technique; 97% with the OTW technique). Periprocedural bleeding events from the introducer occurred in 26.7% of the patients with OTW technique towards not considerable bleeding in the DCI group (p=0.003). Conclusion For US-guided fluoroscopic PICC insertion in adults, the DCI technique was superior as compared to the OTW technique in terms of procedure time.Trial registration NCT 04303052