Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution

Abstract

Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution Background: Bedside insertion of peripherally inserted central catheters (PICCs) has higher rates of malposition than fluoroscopic-guided PICC placement. This study evaluated the success rate of bedside PICC placement, variations in tip location, and risk factors for malposition. Methods: This retrospective study included patients who underwent bedside PICC placement from January 2013 to September 2014 in a single institution. The procedure was conducted under ultrasound guidance or by a blind method. After PICC placement, tip location was determined by chest X-ray. Results: The overall venous access success rate with bedside PICC placement was 98.1% (1,302/ 1,327). There was no significant difference in the venous access success rate between ultrasound-guided placement (868/880, 98.6%) and a blind approach placement (434/447, 97.1%). Optimal tip position was achieved on the first attempt in 1,192 cases (91.6%). Repositioning was attempted in 65 patients; 60 PICCs were repositioned at the bedside, two PICCs were repositioned under fluoroscopic guidance, and three PICCs moved to the desired position without intervention. Final optimal tip position after repositioning was achieved in 1,229 (94.4%). In logistic regression analysis, five factors associated with tip malposition included female sex (Exp(B), 1.687; 95% confidence interval [CI], 1.180 to 2.412; P=0.004), older age (Exp(B), 1.026; 95% CI, 1.012 to 1.039; P < 0.001), cancer (Exp(B), 0.650; 95% CI, 0.455 to 0.929; P = 0.018), lung disease (Exp(B), 2.416; 95% CI, 1.592 to 3.666; P < 0.001), and previous catheter insertions (Exp(B), 1.262; 95% CI, 1.126 to 1.414; P < 0.001). Conclusions: Bedside PICC placement without fluoroscopy is effective and safe in central venous catheters. Potential risk factors associated with catheter tip malposition include older age, female sex, cancer, pulmonary disease, and previous central vein catheterizations.

Ultrasound-guided insertion of peripherally inserted central catheter after anesthetic induction in children undergoing surgery for moyamoya disease - Thirty cases report-

“…In recent studies, success rates defined as proper positioning of the PICC catheter with ultrasound-guided insertion have been reported to be about 81.2% and 94.4% [ 10 , 11 ] in adults and 83.9% [ 12 ] in children. Our success rate of 73.3% was relatively lower than these results.…”

“…The incidence of malpositioning of the catheter tip is reported to be higher with ultrasound guidance than with fluoroscopic guidance [ 13 ] and varies from 8.4% to 27% [ 10 , 13 ]. In our study, the malpositioning rate of the inserted cases was 18.5%, which is consistent with these results.…”

“…After the end of the surgery, the position of the tip of the catheter was checked via chest radiography (CXR) at the intensive care unit or the post-anesthesia care unit. The tip position was classified into three categories: “Optimal” for those located within a 3-cm margin from the cavo-atrial junction, “suboptimal” if they were within the superior vena cava (SVC) or the right atrium, but located outside the 3-cm margin from the cavo-atrial junction, or “malpositioned” in cases involving vessels at locations other than the SVC [ 10 ]. We defined success as the optimal or suboptimal position of the catheter tip in the postoperative CXR.…”

Prevalence of complications associated with the use of a peripherally inserted central catheter in newborns: A systematic review protocol

“…Previous studies have identified risk factors for complications associated with the use of PICC in NBs, including gestational age (GA), catheter insertion location, catheter tip location, and catheter dwell time, especially when it is installed for greater than 35 days, a factor also associated with an increased catheter-related bloodstream infection [1,4]. Other mechanical complications appear with a lower incidence such as rupture of the catheter, migration of the catheter tip, obstruction, and leakage of drugs [5,6]. These are responsible for several non-elective removals, and many of these can be avoided as they are related to the improper handling of the device [3,7].…”

Incidência de complicações no uso do Peripherally Inserted Central Catheter em uma coorte de adultos hospitalizados

“…Como aparato eficaz, a ultrassonografia tem trazido diversos benefícios durante o procedimento de inserção do PICC, pois contorna um dos principais desafios da técnica cega ou convencional, uma vez que auxilia a encontrar uma veia com bom diâmetro para o procedimento, minimizando os ricos para o paciente (DAWSON, 2011;KWON et al, 2020). Além da ultrassonografia, existem outras técnicas recomendadas e aplicadas por diversos profissionais, como a fluoroscopia (BOO et al, 2020;CHAN et al, 2017) e tecnologias de navegação que permitem a visualização em tempo real da localização do cateter (TOMASZEWSKI et al, 2017).…”