Researchers at Northwestern University in Chicago have found that, per procedure, using ultrasound with electrocardiography to guide insertions of central venous catheters via the arm is only somewhat less costly than the conventional method, external measurements with confirmatory chest x-rays. However, the savings can add up for interventional radiology practices that perform a lot of such insertions to administer drugs, test blood or measure pressure during procedures.
The study was published online Feb. 14 in the Journal of Vascular and Interventional Radiology.
Senior author Jeremy Collins, MD, and colleagues had clinicians perform 68 ultrasound/EKG-guided placements of peripherally inserted central catheters (PICCs) in 63 outpatients. For comparison, they had the same clinicians perform PICC placement using the standard measuring technique in 68 otherwise matched procedures.
Confirming tip positioning with chest x-rays and assessed agreement between the two approaches, the team found the guided PICC placements needed less repositioning (1.5 percent vs. 10.3 percent) and yielded more catheters optimally positioned (86.8 percent vs. 67.6 percent).
Due to these results, guided placements cost less per procedure—$319 vs. $381—even though the total cost of the guided placement across the study was higher, $18,794 vs. $17,546.
In their discussion, the authors noted that the modest per-procedure savings of guided over conventional placement “could translate into impactful cost savings” in a high-volume practice.
“Changing practice, while disruptive, can result in improved procedural throughput and improved cost savings,” Collins et al. commented. “New technologies should be validated and potentially adopted by interventional radiologists when time, outcomes and costs may prove favorable. Considering a guided system for PICC placement might serve as a launching point for such efforts.”