Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2024 Jan;25(1):5-13.
doi: 10.1177/11297298221099838. Epub 2022 May 27.

The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion

Fabrizio Brescia  1 , Mauro Pittiruti  2 , Timothy R Spencer  3 , Robert B Dawson  4
Affiliations
Editorial

The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion

Fabrizio Brescia et al. J Vasc Access. 2024 Jan.

Abstract

Insertion of Peripherally Inserted Central Catheters (PICCs) is potentially associated with the risk of immediate/early adverse events, some of them minimal (repeated punctures) and some relevant (accidental arterial puncture or nerve-related injury). Several strategies adopted during the insertion process may minimize the risk of such events, including late complication risks such as infection, venous thrombosis, or catheter dislodgment and/or malposition. This paper describes an update version of the SIP protocol (Safe Insertion of PICCs), an insertion bundle which includes eight effective strategies that aims to minimize immediate, early, or late insertion-associated complications. These strategies include: preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; appropriate skin antiseptic technique; choice of appropriate vein, adoption of the Zone Insertion Method™; clear identification of the median nerve and brachial artery; ultrasound-guided puncture; ultrasound-guided tip navigation; intra-procedural assessment of tip location; correct securement of the catheter, and appropriate protection of the exit site. This updated version of the SIP protocol includes several novelties based on the most recent evidence-based scientific literature on PICC insertion, such as the clinical relevance of the tunneling technique, the use of ultrasound for intra-procedural tip navigation and tip location, and the new technologies for the protection of the exit site (cyanoacrylate glue) and for the securement of the catheter (subcutaneous anchorage).

Keywords: Techniques and procedures; central venous catheterization; patient safety; peripheral venous catheterization; peripherally inserted central catheters; standardized assessment; ultrasound imaging.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Step 1: Visualization of the cephalic vein at the antecubital fossa.
Figure 2.
Figure 2.
Step 2: Identification of the artery and brachial veins and visualization of the confluence between the antecubital vein and basilic vein.
Figure 3.
Figure 3.
Step 3: Identification of the basilic vein along the bicipital-humeral groove, sliding the probe upwards.
Figure 4.
Figure 4.
Step 4: Examination of the nerve-vascular bundle of the arm.
Figure 5.
Figure 5.
Step 5: Visualization of the cephalic vein, moving laterally over the biceps muscle.
Figure 6.
Figure 6.
Step 6: Rapid examination of the axillary vein in the infraclavicular area.
Figure 7.
Figure 7.
Step 7: Visualization of the subclavian, brachiocephalic, and internal jugular vein in the supraclavicular area.
See this image and copyright information in PMC

References

    1. Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014; 3(4): 80–94. - PMC - PubMed
    1. Smith RJ, Cartin-Ceba R, Colquist JA, et al.. Peripherally inserted central catheter placement in a multidisciplinary intensive care unit: a preliminary study demonstrating safety and procedural time in critically ill subjects. J Vasc Access 2021; 22(1): 101–106. - PubMed
    1. Ku T, Govindan S, Claar D, et al.. Peripherally inserted central catheters versus traditional central venous catheters in the ICU: are there differences? A cross-sectional survey of thirteen Michigan hospitals. In: B105. Critical care: counterparts – non-pulmonary critical care and multi-organ failure. Dallas, TX: American Thoracic Society, 2019, pp. A4143–A4143.
    1. Gupta N, Gandhi D, Sharma S, et al.. Tunneled and routine peripherally inserted central catheters placement in adult and pediatric population: review, technical feasibility, and troubleshooting. Quant Imaging Med Surg 2021; 11(4): 1619–1627. - PMC - PubMed
    1. Krein SL, Saint S, Trautner BW, et al.. Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study. BMJ Qual Saf 2019; 28(7): 574–581. - PMC - PubMed

Publication types

MeSH terms