{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:04:44Z","timestamp":1790229884745,"version":"4.1.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether the one-step sheath insertion technique is non-inferior to the conventional two-step technique with respect to first-attempt sheath insertion success in adults undergoing peripherally inserted central catheter (PICC) placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, single-center, outcome-assessor-blinded, randomized non-inferiority trial included 500 adult patients undergoing PICC placement, who were randomly assigned 1:1 to the one-step or two-step sheath insertion group. The primary outcome was first-attempt sheath insertion success, with a prespecified non-inferiority margin of \u22125 percentage points. Secondary outcomes included intraoperative and 24-hour puncture-site bleeding, insertion-site infection, and phlebitis within 7 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      First-attempt sheath insertion was successful in 92.0% (230\/250) of patients in the one-step group and 95.6% (239\/250) in the two-step group. The absolute risk difference was \u22123.6 percentage points (95% CI, \u22127.8 to 0.6), and the lower confidence bound crossed the prespecified non-inferiority margin; therefore, non-inferiority was not demonstrated. Intraoperative puncture-site bleeding was less severe in the one-step group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), although this was a secondary outcome based on semi-quantitative assessment. No significant between-group difference was observed in bleeding at 24\u2005h (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.623). Insertion-site infection occurred in 0.4% of patients in each group, and phlebitis occurred in 1.2% and 0.8% of patients in the one-step and two-step groups, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The one-step sheath insertion technique did not demonstrate non-inferiority to the conventional two-step technique for first-attempt sheath insertion success. Although less severe intraoperative puncture-site bleeding was observed with the one-step technique, this secondary finding should be interpreted cautiously. The present findings do not support routine replacement of the two-step technique.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1921555","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:43:50Z","timestamp":1790228630000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of two blunt dissection sheath insertion techniques in peripherally inserted central catheter placement: a randomized non-inferiority trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Dongting","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Nursing, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibei","family":"Wan","sequence":"additional","affiliation":[{"name":"School of Medicine, Tongji University","place":["Shanghai, China"]},{"name":"Department of Nursing, Shanghai Chongming District Infectious Disease Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongling","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congcong","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, 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