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

Abstract

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.

Defining peripherally inserted central catheter tip position and an evaluation of insertions in one unit

“…inserted peripherally inserted central catheters to a length determined by the height of the patient. They accepted a tip position up to 3 cm above or below the sternal angle and reported a malposition rate of up to 75% . These rates, despite the different methods employed, are consistent with our findings.…”

New formulas to predict the length of a peripherally inserted central catheter based on anteroposterior chest radiographs

“…16 Studies have suggested various methods for estimating the ideal position of the central catheter tip, and most agree that the optimal target is the “cavoatrial junction.” Many studies have offered methods to predict optimal catheter length in the situation of blind bedside PICC insertion without fluoroscopy. Among these, PICC length was predicted using bone and soft-tissue landmarks, 22–24 while others used patient height. 11,12,25,26 Some studies introduced the VBU method and suggested that 2.0–2.4 VBU below the carina is a reliable estimate of the position of the cavoatrial junction.…”

Risk factors for development of complication following peripherally inserted central catheters: A retrospective analysis of 850 patients

“…In the case of failure following 2 attempts, the procedure should be handed over to a more experienced staff member. J Clin Exp Invest 2014; 5 (1): 29-35…”

“…Peripherally inserted central venous catheters (PICCs) are devices that can be inserted into the central veins near the heart through the upper extremity veins. Using peripheral veins for central venous access is a safe alternative to central venous catheterization with low cost and a low complication rate [1][2][3][4][5].…”