Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement

Glauser, Frédéric; Breault, Stéphane; Rigamonti, Fabio; Sotiriadis, Charalampos; Jouannic, Anne-Marie; Qanadli, Salah D.

doi:10.1007/s00330-016-4666-y

Cited by 42 publications

(60 citation statements)

References 25 publications

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“…The malposition of the catheter tip may occur at the time of insertion or later on as a result of spontaneous migration due to anatomic positioning or pressure changes within the thoracic cavity [18,19]. The malposition rate is known to be between 1.8%-9.3% for non-PICC type CVCs [20,21] and 10% and 53% for PICCs [8,9]. In our study, malposition on the initial chest radiograph was found in 110 cases (8.5%).…”

Section: Discussionmentioning

confidence: 55%

“…Complications include catheter malposition, migration, occlusion, infection, and venous thrombosis [5,7]. Amidst these complications, the occurrence of catheter malposition increases when PICC placement is performed as a bedside procedure without fluoroscopic guidance [8]. The estimated rate of tip malposition with bedside PICCs varies between 10% and 53% [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Amidst these complications, the occurrence of catheter malposition increases when PICC placement is performed as a bedside procedure without fluoroscopic guidance [8]. The estimated rate of tip malposition with bedside PICCs varies between 10% and 53% [8,9]. Tip malposition can cause other complications, such as catheter malfunction and thrombotic occlusion of the catheter or catheter-related deep vein thrombosis [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Transthoracic echocardiography has been suggested to determine catheter tip position, but randomized, controlled trials (RCT) have not been published and expertise with the technique and equipment is not widely available . The frequency of unsuccessful and complicated insertions without imaging (eg, at the bedside) remains unacceptably high and should not be routinely attempted in high‐risk patients . Collaboration between vascular access nurses and interventional radiologists may offer improved outcomes compared with bedside insertion …”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

“…64,65 The frequency of unsuccessful and complicated insertions without imaging (eg, at the bedside) remains unacceptably high and should not be routinely attempted in high-risk patients. 66,67 Collaboration between vascular access nurses and interventional radiologists may offer improved outcomes compared with bedside insertion. 68 Emergent and urgent devices (ie, "temporary catheters") placed without maximum sterile barrier precautions, or catheters with tips positioned at a distance from the cavoatrial junction, should be removed as soon as possible after stabilization of the patient.…”

Section: Elective Access Conditionsmentioning

confidence: 99%

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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Comparing the accuracy and complications of peripherally inserted central catheter (PICC) placement using fluoroscopic and the blind pushing technique

Erskine

Bradley

Joseph

et al. 2021

J of Medical Radiation Sci

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Introduction: Peripherally inserted central catheters (PICCs) offer a convenient long-term intravenous access option. Different methods exist for insertion including the use of continuous fluoroscopy for guidance, or bedside insertion techniques. The blind pushing technique is a bedside approach which involves advancing a PICC through the access sheath without imaging guidance, before taking a mobile chest radiograph to confirm tip position. Obtaining optimal position is a critical aim of PICC placement as malpositioned lines have been associated with higher complications including death. We aimed to assess the accuracy of PICC placement by comparing the tip position and complications for lines placed under fluoroscopic guidance to those placed without fluoroscopic guidance. Methods: The Radiology Information System was used to identify 100 continuous PICC insertions in each group (fluoroscopic and blind pushing) between 1 January and 12 May 2019. Patients were excluded if there was a known history of central venous occlusion/stenosis. Results: In the fluoroscopic-guided group, 0% of the lines were malpositioned compared with 60% of the lines placed using the blind pushing technique, P < 0.001. Fluoroscopic-guided PICC insertions were in place for a total of 2446 days and demonstrated 6 complications (2.45 complications per 1000 catheter days). This compared with blind pushing technique PICC insertions which were in place for a total of 1521 days and demonstrated 18 complications (11.83 complications per 1000 catheter days), P = 0.004. Conclusion: The use of fluoroscopy for PICC placement leads to significant improvements in tip accuracy than for PICCs placed using the blind pushing technique. While the use of these imaging resources incurs cost and time, these factors should be balanced in order to offer patients the safest and most accurate method of line insertion.

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Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement

Abstract: • Bedside and fluoroscopy guided techniques are commonly used for PICC placement. • Catheter malposition is the major technical issue with the bedside technique. • Catheter malposition occurred in 53% of patients with the bedside technique.

Cited by 42 publications

References 25 publications

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

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

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Comparing the accuracy and complications of peripherally inserted central catheter (PICC) placement using fluoroscopic and the blind pushing technique

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