The EKG Method for Positioning the Tips of PICCs: Results from Two Preliminary Studies

Pittiruti, Mauro; Scoppettuolo, Giancarlo; Greca, Antonio La; Emoli, Alessandro; Brutti, Alberto; Migliorini, Ivano; Dolcetti, Laura; Taraschi, Cristina; Pascale, Gennaro De

doi:10.2309/java.13-4-4

Cited by 58 publications

(47 citation statements)

References 30 publications

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“…Between January 1, 2007, and May 31,2009, 225 PICCs were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned (not in the lower third of the SVC).…”

Section: Resultsmentioning

confidence: 99%

“…Still other devices can help locate the tip of a PICC, such as the Sherlock Tip Location System 42 and the Electromagnetic Detection System, 41 but these private devices are expensive and the operator needs special training. 31,42,43 On the other hand, radiographic confirmation of the tip location cannot be omitted even if the PICC was inserted with the help of all these devices. According to the Infusion Nurses Society's 2006 standards of practice, 19 locations of all central catheter tips shall be determined radiographically and documented before the start of the prescribed therapy.…”

Section: Discussionmentioning

confidence: 99%

“…To place the tip of a PICC in the proper location, Pittiruti et al 31 reported an electrocardiographic method of determining the terminal location of the tip during insertion of the PICC. This method uses the changes in the P wave of the electrocardiogram to monitor the tip of the PICC during insertion.…”

Section: Discussionmentioning

confidence: 99%

“…18,31 Because the external measurement can never exactly duplicate the internal venous anatomy, tip malposition is relatively frequent with bedside placement of PICCs. [31][32][33][34] Sometimes the tip of the PICC is not in the SVC, and sometimes the tip of PICC is in the SVC but not in the best spot, in the lower third of the SVC. When using the sternal notch and the third intercostal space as landmarks, nurses have a 65% to 70% success rate of placing the catheter tip in the lower third of the SVC on the first try.…”

Section: Shortcomings Of the Standard Procedures For Picc Insertionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Shortcomings Of the Standard Procedures For Picc Insertionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…), both with open-ended or closed ended tip. The electrocardiographic methodology presents several important features: has the same accuracy of the fluoroscopy, however, it is easier to use, more promptly accessible, more secure and, therefore, has a major cost-effectiveness [63,[71][72][73][74][75][76] (Figure 7). …”

Section: Cotogni P Et Al Piccs In Critically Ill Patientsmentioning

confidence: 99%

Focus on peripherally inserted central catheters in critically ill patients

Cotogni

Pittiruti

2014

WJCCM

105

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Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e. , low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. 80November 4, 2014|Volume 3|Issue 4| WJCCM|www.wjgnet.com access devices (CVADs) are key elements of management for either adult or pediatric critically ill patients. Healthcare pro...

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Dual‐wavelength reflectance spectroscopy of the superior vena cava: A method for placing central venous catheters at the cavoatrial junction

Stringer

Shumway²,

Holbrook

et al. 2017

Journal of Biophotonics

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There are a limited number of methods to guide and confirm the placement of a peripherally inserted central catheter (PICC) at the cavoatrial junction. The aim of this study was to design, test and validate a dual-wavelength, diode laser-based, single optical fiber instrument that would accurately confirm PICC tip location at the cavoatrial junction of an animal heart, in vivo. This was accomplished by inserting the optical fiber into a PICC and ratiometrically comparing simultaneous visible and near-infrared reflection intensities of venous and atrial tissues found near the cavoatrial junction. The system was successful in placing the PICC line tip within 5 mm of the cavoatrial junction.

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The EKG Method for Positioning the Tips of PICCs: Results from Two Preliminary Studies

Cited by 58 publications

References 30 publications

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

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

Focus on peripherally inserted central catheters in critically ill patients

Dual‐wavelength reflectance spectroscopy of the superior vena cava: A method for placing central venous catheters at the cavoatrial junction

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