Nurse-Performed Point-Of-Care Ultrasound-guided Peripherally Inserted Central Catheter Insertion: A Standardized Nursing Protocol

Summary

This article presents a standardized nursing protocol for point-of-care ultrasound–guided peripherally inserted central catheter insertion in adults, detailing vein assessment, real-time ultrasound-guided puncture, catheter advancement, and nursing decision-making to support safe and reproducible clinical practice.

Abstract

This article presents a standardized, evidence-informed nursing protocol for point-of-care ultrasound–guided peripherally inserted central catheter (PICC) placement in adult patients. Rather than serving as a validation study, this work provides a structured procedural framework that translates current best evidence into a reproducible, step-by-step approach to support safe and consistent bedside practice by trained nurses. The protocol is organized using an operational adaptation of the Indication–Acquisition–Interpretation–Nursing Decision-Making framework to guide both clinical reasoning and technical execution. It details ultrasound system preparation, patient positioning, infection prevention, ultrasound-based vein assessment, real-time ultrasound-guided venipuncture using the modified Seldinger technique, catheter advancement, and post-insertion tip verification strategies. Key technical elements including probe selection, image optimization, catheter-to-vein ratio assessment, and troubleshooting in technically challenging cases are explicitly defined. Nursing decision-making related to catheter maintenance, post-insertion care, and patient education is also integrated. By incorporating ultrasound as an extension of bedside vascular assessment, this protocol aims to reduce mechanical complications, minimize multiple puncture attempts, and improve procedural accuracy. This standardized approach promotes patient safety, reduces variability in clinical practice, and supports the implementation of ultrasound-guided PICC placement as an advanced, evidence-based nursing intervention across diverse healthcare settings.

Introduction

Venous access is a fundamental component of patient care across a wide range of clinical settings. However, establishing and maintaining reliable vascular access remains challenging, particularly among individuals with difficult intravenous access (DIVA). The type of vascular access device (VAD), clinical context, and patient-related factors influence the risk of complications, including extravasation, thrombosis, local and bloodstream infections, occlusions, and catheter rupture¹. In this context, the peripherally inserted central catheter (PICC) is recognized as a safe and effective option for medium- to long-term intravenous therapies, inclu....

Protocol

This study was approved by the Institutional Review Board of the Ribeirão Preto College of Nursing, University of São Paulo (CAAE No. 78296623.2.0000.5393). Written informed consent was obtained from all participants. All ultrasound images were collected and used with explicit authorization. This protocol follows an operational adaptation of the Indication–Acquisition–Interpretation–Nursing Decision-Making (I-AIN) framework¹⁶ to guide the step-by-step execution of ultrasound-guided PICC insertion and support reproducible nursing practice. The research tools, equipment and materials used in this protocol are listed in Table of Materials<....

Results

A successful application of this standardized protocol is characterized by clear ultrasound visualization of the target vein, real-time tracking of needle and guidewire entry, and smooth catheter advancement without resistance. Final catheter tip positioning is confirmed using radiography, ultrasound, or intracavitary electrocardiography (IC-ECG), depending on availability and clinical context.

The representative images provided in this manuscript (Figures 1–7) illustrat.......

Discussion

Compared with traditional landmark-based methods, ultrasound-guided PICC insertion has clear clinical relevance because it enables direct vascular visualization, improves first-attempt success rates, and reduces mechanical complications⁷˒²³˒²⁴. This protocol structures nursing practice using an adapted Indication–Acquisition–Interpretation–Nursing Decision-Making (I-AIN) model¹⁶, providing a cohesiv.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
1 mL syringe and 13 × 45 mm needle	BD Luer Lock	9421	Syringe and needle for injection
10 mL syringe	BD Luer Lock	990172	Syringe for fluid administration
10ml syringe	BD Luer Lock	990172	1un for flushing
1ml syringe and 13 x 45 mm needle	BD Luer Lock	9421	1 un For anesthetic
Chlorhexidine solution	Riohex 0.5%	FDS039	Antiseptic solution for skin preparation
Device for sutureless fixation	Health Line	A14-04160	Catheter securement device
Device for sutureless fixation	Health Line	A14-04160	1un
Disposable surgical cap	Descarpack	93201	Disposable head covering
Disposable surgical mask	Descarpack	110601	Disposable face mask
Kit PICC catheter (Introducer needle, Guidewire, Dilator, Blade)	Health Line	A14-04160	01 un
Leaded glasses	Valeplast	CA. 40186	Protective eyewear
Leaded glasses	Valeplast	CA. 40186	1un
Local anesthetic (1 ou 2% lidocaine)	Xylestesin 2%	7.89668E+12	1un
Local anesthetic (1% or 2% lidocaine)	Xylestesin 2%	7.90E+12	Local anesthetic agent
Measuring tape	Premium	B0FX34MZ1C	Device for length measurement
PICC catheter kit (introducer needle, guidewire, dilator, blade)	Health Line	A14-04160	Complete catheter insertion kit
Sterile gloves	Sensitex	10092410023	Sterile hand protection
Sterile saline solution for flushing	Equiplex	47760	Sterile solution for catheter flushing
Sterile saline solution for flushing	Equiplex	47760	5un
Sterile surgical drape	Sorb Drape POLARFIX	F08273	Sterile barrier drape for procedural field
Sterile surgical gown	Shanghai Medplus Medical Supply Co., Ltd	CA 42.581	Sterile protective garment
Sterile ultrasound probe covers, latex-free (kit)	Mediss	B085ZL2MT2	Sterile cover for ultrasound transducer
Tablet	Samsung Galaxy	RX2X700EB6D	Device for image display and documentation
Ultrasound machine with high-frequency transducer	RC Medical - 3 in one	WXPCEDK002	Ultrasound system for vascular imaging