Central venous access is critical for administering intravenous medications, parenteral nutrition, and fluid therapy in intensive care units (ICUs). Peripherally inserted central catheters (PICCs) provide an alternative to traditional centrally placed catheters, but they can be associated with complications such as blood clots (thrombosis), catheter-related infections, and mechanical blockages. The primary purpose of this study is to assess the procedural efficacy, functional lifespan, and complication rates of ultrasound-guided PICCs in critically ill adult patients.
In this prospective observational study, 60 adult ICU patients who require central venous access for at least 5 to 7 days will undergo bedside PICC placement by radiology staff using real-time ultrasound guidance and the modified Seldinger technique. Proper positioning of the catheter tip will be verified by a portable chest radiograph immediately after insertion.
Participants will be monitored daily while the catheter remains in place until line removal, ICU discharge, or death. Surveillance includes daily clinical site inspections, structured laboratory assessments, and scheduled compression Doppler ultrasound scans to check for blood clots in the cannulated arm. If an infection or blockage is suspected, appropriate blood cultures and diagnostic work-ups will be conducted. The gathered data will determine the insertion success rate, functional patency rate, and the overall incidence of complications per 1,000 catheter-days to establish evidence-based guidelines for vascular access in critical care.
Adult patients aged ≥ 18 years admitted to the Intensive Care Unit (ICU)
Clinical requirement for central venous access via a peripherally inserted central catheter (PICC) (e.g., difficult peripheral venous access, parenteral nutrition, prolonged intravenous antibiotic therapy ≥ 5 days, or infusion of vesicant/vasoactive medications)
Anticipated need for central venous access or ICU stay of at least 5 to 7 days
Patient or legal representative willing and able to provide written informed consent
Age below 18 years
Known hypersensitivity or allergy to catheter material (polyurethane or silicone)
Local skin infection, cellulitis, or active thrombosis at the intended insertion site
Documented ipsilateral upper-extremity or superior vena cava venous obstruction/stenosis precluding catheter passage
Adult critically ill patients aged 18 years or older admitted to the Intensive Care Unit (ICU) at Assiut University Hospital who require central venous access via a peripherally inserted central catheter (PICC) for clinical indications such as difficult peripheral venous access, administration of parenteral nutrition, prolonged intravenous antibiotic therapy (≥5 days), infusion of vesicant or vasoactive medications, or frequent blood sampling, with an anticipated need for central venous access or ICU stay of at least 5 to 7 days.
Cohort
Prospective
Not listed
Number of Participants With at Least One PICC-Related Complication
Number of patients who experience at least one PICC-related complication (including catheter occlusion, accidental dislodgement, catheter-related bloodstream infection confirmed per CDC/NHSN criteria, or catheter-related venous thrombosis confirmed by Doppler ultrasound) during the catheter dwell period.
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