Bedside peripherally inserted central catheter placement in trauma intensive care unit in South Korea: a comparative analysis of safety and tip positioning accuracy

Background: Transporting critically ill trauma patients for fluoroscopy-guided peripherally inserted central catheter (PICC) placement poses substantial risks. This study evaluated the clinical outcomes of bedside PICC insertion using a surface anatomical landmark-based measurement in a trauma intensive care unit (ICU).Methods: This retrospective cohort study included trauma ICU patients who underwent PICC insertion between September 2023 and August 2024 at a regional trauma center. Insertion location was categorized as bedside or fluoroscopy-guided. Outcomes included optimal tip positioning, aberrant-course malposition, complication rates, and catheter dwell time. Multivariable linear regression identified factors associated with PICC duration.Results: Among 282 PICC procedures (171 bedside, 111 fluoroscopy), the bedside group had significantly higher injury severity scores and more frequent mechanical ventilation. Using the cm-based carina-distance criterion, optimal tip positioning was achieved in 73.1% of bedside and 65.5% of evaluable fluoroscopy-guided insertions (P=0.184). However, using the vertebral body unit-based radiologic criterion, target-zone achievement was lower in the bedside group than in the fluoroscopy group (48.5% vs. 64.9%). Initial aberrant-course malposition occurred in nine bedside insertions (5.3%) and in no fluoroscopy-guided insertions, and all were corrected before clinical use. Overall complication rates were comparable (17.5% vs. 18.0%, P=0.919). Conclusions: Bedside PICC insertion using a surface anatomical measurement method may be a feasible transport-free option for selected critically ill trauma ICU patients.