{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:23:23Z","timestamp":1790270603921,"version":"4.1.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Mechanical complications remain common with the placement of peripherally inserted central catheters (PICCs), particularly in critically ill patients. Given the need to minimise procedural complications, strategies for reducing bleeding during PICC placement are essential. This study evaluated the efficacy of a previously introduced two-stage technique in minimising insertion-related bleeding compared with the traditional modified Seldinger technique in ICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study included 86 patients who underwent 92 PICC placements in the ICU of a tertiary university medical centre, between August 2022 and January 2025. Bleeding outcomes were assessed at three time points: 5\u2009min, 30\u2009min and within 24\u2009h after insertion. Blood loss was evaluated semi-quantitatively based on the extent of gauze pad contamination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 56 were performed using the two-stage technique and 36 using the traditional method. Baseline characteristics were comparable between the two groups. Bleeding incidence was significantly lower in the two-stage group at all time points. At 5\u2009min post-insertion, 93% of the patients in the two-stage group had no visible or only minimal bleeding compared to 28% in the traditional group. At 30\u2009min, 84% had no visible or only minimal bleeding compared with 14% (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariate analysis, the two-stage technique was independently associated with a reduced bleeding risk (OR, 0.019; 95% CI, 0.005\u20130.074;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). An interaction analysis showed that aPTT significantly modified the association between technique and bleeding (OR, 20.519; 95% CI, 1.643\u2013255.851;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The modified two-stage technique appears to be a feasible alternative to conventional PICC placement and was associated with reduced insertion-related bleeding in ICU patients. The technique also resulted in fewer dressing changes within 24\u2009h, suggesting more stable haemostasis and potential improvements in ICU care quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298251376981","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T07:07:35Z","timestamp":1759475255000},"page":"978-987","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Bleeding outcomes of a modified two-stage sheath\u2013dilator technique for peripherally inserted central catheter placement in ICU patients: A retrospective cohort study"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5145-0743","authenticated-orcid":false,"given":"Ting-Chia","family":"Young","sequence":"first","affiliation":[{"name":"Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan"},{"name":"Department of Medicine, Mackay Medical University, New Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8166-2011","authenticated-orcid":false,"given":"Kuang-Hua","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mackay Medical University, New Taipei, Taiwan"},{"name":"Department of Critical Medicine, Mackay Memorial Hospital, Taipei, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9679-1789","authenticated-orcid":false,"given":"Ying-Hung","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Mackay Memorial Hospital, Taipei, Taiwan"},{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4196-643X","authenticated-orcid":false,"given":"Tzu-Chun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mackay Medical University, New Taipei, Taiwan"},{"name":"Department of Anaesthesiology, Mackay Memorial Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0276-1500","authenticated-orcid":false,"given":"Kuan-Pen","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mackay Medical University, New Taipei, Taiwan"},{"name":"Department of Critical Medicine, Mackay Memorial Hospital, Taipei, Taiwan"},{"name":"Department of Anaesthesiology, Mackay Memorial Hospital, Taipei, 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