Blind placements of peripherally inserted antecubital central catheters: initial catheter tip position in relation to carina

Thiruvenkatarajan, Venkatesan; Sen, Neilayan; Korula, Pritish John; Surendrababu, Narayanam R. S.; Raj, John Prakash; John, Phillip; Christopher, Solomon

doi:10.1093/bja/ael316

Cited by 39 publications

(52 citation statements)

References 20 publications

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“…found that though a central location was the most common tip position for right-sided PICCs, the brachiocephalic vein (ipsilateral) was the commonest location for left-sided ones. [34] In contrast, our study showed that acceptable positioning of catheter tips was not statistically different for right- and left-sided catheters.…”

Section: Discussioncontrasting

confidence: 75%

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Evaluation of length of central venous catheter inserted via cubital route in Indian patients

Joshi¹,

Kulkarni²,

Bhargava³

2010

Indian Journal of Critical Care Medicine

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Aim:Peripherally inserted central venous catheters (PICCs) are popular due to the ease of insertion, low cost and low risk of complications. Anteroposterior (AP) chest radiograph (CXR) is then obtained to assess the location of the catheter tip. But poor-quality X-rays remain a significant problem. We planned a study using radiopaque marker at sternal angle, as a radiological landmark, to relate height of the patient and optimal length of PICC fixation, at the antecubital fossa, and to know the incidence of malpositioning.Materials and Methods:A total of 200 patients aged above 20 years, scheduled for elective major cancer surgeries were studied. Vygoflex PUR, 16-G catheter, length 70 cm was used. The right or the left arm was chosen depending on the availability of veins. Catheter tip was observed in the post procedure CXR.Results:200 patients [100 patients in group 1 (length of catheter fixation at antecubital fossa 45 cm) and 100 patients in group 2 (length of catheter fixation 50 cm)] were enrolled. The groups were further subdivided into 1a, 1b, 2a, 2b and results tabulated.Conclusions:Appropriate length of catheter fixation for group 1a was <45 cm, group 1b = 45 cm, group 2a = 50 cm, and for group 2b it was ≥50 cm. Gender and arm (right or left) did not have any bearing on the length of fixation. Incidence of malpositioning (15.5%) was more in right-sided catheters, more so, in short heighted people. PICC insertion via cubital route stands better compared with other routes, viz., Internal jugular vein IJV, subclavian and femoral.

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Section: Discussioncontrasting

confidence: 75%

“…reported 11% of PICC entering the IJV. [34] An 18% incidence has been reported in two different studies by Ragasa and coworkers and Burgess and colleagues. [2235] The same incidence quoted in pediatric population ranges from 14 to 37%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of length of central venous catheter inserted via cubital route in Indian patients

Joshi¹,

Kulkarni²,

Bhargava³

2010

Indian Journal of Critical Care Medicine

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“…That incidence of malposition is similar to the incidences reported in other studies. 32,38,39 Malpositioned tips were located in the upper or middle third of the SVC, the ipsilateral subclavian vein, the right atrium, the ipsilateral internal jugular vein, and the axillary vein. In 1 case, the tip was coiled in the SVC (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…The tip locations and incidences are similar to those reported in other studies. 32,38,39 These reports show that about 58% of malpositions were corrected with catheter exchange, and 83% were corrected by repositioning the catheter in the interventional radiology division under imaging guidance. 32,38,39 In this study, we demonstrated a modification of PICC insertion: taking the chest radiograph earlier, which makes it easier to correct malpositions at the bedside, with high success rates and without catheter exchange.…”

Section: Discussionmentioning

confidence: 99%

Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier

Tian

Chen

et al. 2011

Critical Care Nurse

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Placement of the tip of a peripherally inserted central catheter in the lower third of the superior vena cava is essential to minimize the risk of complications. Sometimes, however, the catheter tip cannot be localized clearly on the chest radiograph, and repositioning a catheter at bedside is difficult, sometimes impossible. A chest radiograph obtained just after the catheter is inserted, before the guidewire is removed, can be helpful. With the guidewire in the catheter, the catheter and its tip can be seen clearly on the radiograph. If the catheter was inserted via the wrong route or the tip is not at the appropriate location, the catheter can be repositioned easily with the guidewire in it. Between January 1, 2007, and May 31, 2009, 225 catheters were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned. The tips of all these catheters were repositioned in the lower third of the superior vena cava by using this method. No catheter was exchanged or removed. The infection rate for catheter placement did not increase when this method was used. This modification facilitates accurate location of the catheter tip on the chest radiograph, making it easy to correct any malposition (by withdrawing, advancing, or even reinserting the catheter after withdrawal).

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“…PICCs have recently become popular because they perform well in overcoming problems associated with limited peripheral access and frequent venipuncture in patients undergoing long-term therapy. In particular, blind PICCs -those done without an imaging assistant -have been used by many institutions for easy, cost effective, and safe placement [6,7]. For burn patients, PICCs were compared with CVCs for both use and safety issues, and PICCs performed well in relation to CR-BSI [8].…”

Section: Introductionmentioning

confidence: 99%

Use of blind placements of peripherally inserted central catheters in burn patients: A retrospective analysis

Choi

Changmin

Park

et al. 2015

Burns

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Blind placements of peripherally inserted antecubital central catheters: initial catheter tip position in relation to carina

Cited by 39 publications

References 20 publications

Evaluation of length of central venous catheter inserted via cubital route in Indian patients

Evaluation of length of central venous catheter inserted via cubital route in Indian patients

Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier

Use of blind placements of peripherally inserted central catheters in burn patients: A retrospective analysis

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