Peripherally inserted central catheter with intracavitary electrocardiogram guidance: Malposition risk factors and indications for post-procedural control

Objectives: To confirm the feasibility of intracavitary electrocardiogram guidance to verify tip’s position during insertion of peripherally inserted central catheter and to identify clinical factors or intracavitary electrocardiogram patterns associated with aberrant tip’s position. Methods: A prospective study was conducted in our university hospital after authorization of the ethics committee. All patients addressed for peripherally inserted central catheter insertion were included and received the insertion using intracavitary electrocardiogram and electromagnetic guidance. Side of insertion and three electrocardiogram factors were collected: visualization of P-wave at baseline (sinusal rhythm), acquisition of the maximal P-wave and the negative deflection. All patients had a systematic post-procedural chest X-ray. One of the investigators assessed all chest X-ray, blinded to the results of intracavitary electrocardiogram, and confirmed whether the tip’s position on chest X-ray matched with the intracavitary electrocardiogram information or if the tip was malpositioned on chest X-ray (mismatch with intracavitary electrocardiogram or aberrant position). Factors associated with malposition were described. Results: From January 2015 to April 2015, 330 patients were eligible, 5 had an uninterpretable chest X-ray, and 14 were non-sinusal at baseline. Our main analysis population included 311 patients. We observed a mismatch between intracavitary electrocardiogram and chest X-ray estimate of the tip’s position in 3 cases (1%) and an aberrant tip’s position occurred in 3 cases (1%). Incidence of malposition was higher in the group of patients with non-sinusal rhythm (14%) and when the catheter was inserted on the left side (7%). Conclusion: This study confirmed the feasibility of intracavitary electrocardiogram for peripherally inserted central catheter positioning and the limits of chest X-ray. Insertion on left side may represent risk factor for aberrant position but our study lacked power to establish a statistical link.

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Detection of peripherally inserted central catheter (PICC) in chest X-ray images: A multi-task deep learning model

Computer Methods and Programs in Biomedicine ◽

10.1016/j.cmpb.2020.105674 ◽

2020 ◽

Vol 197 ◽

pp. 105674

Author(s):

Dingding Yu ◽

Kaijie Zhang ◽

Lingyan Huang ◽

Bonan Zhao ◽

Xiaoshan Zhang ◽

...

Keyword(s):

Deep Learning ◽

Learning Model ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

X Ray ◽

Chest X Ray ◽

Deep Learning Model

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Time and resources of peripherally inserted central catheter insertion procedures: a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system

ClinicoEconomics and Outcomes Research ◽

10.2147/ceor.s121230 ◽

2017 ◽

Vol Volume 9 ◽

pp. 115-125 ◽

Cited By ~ 16

Author(s):

Kenneth Tomaszewski ◽

Nicole Ferko ◽

Sarah Hollmann ◽

Simona Eng ◽

Howard Richard ◽

...

Keyword(s):

Real Time ◽

Catheter Insertion ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

X Ray ◽

Blind Insertion ◽

Chest X Ray

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Unusual malposition of a peripherally inserted central catheter into the left pericardiophrenic vein: A case report

The Journal of Vascular Access ◽

10.1177/11297298211018945 ◽

2021 ◽

pp. 112972982110189

Author(s):

Alfonso Piano ◽

Annamaria Carnicelli ◽

Emanuele Gilardi ◽

Nicola Bonadia ◽

Kidane Wolde Sellasie ◽

...

Keyword(s):

Atrial Fibrillation ◽

Superior Vena ◽

Vena Cava ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

X Ray ◽

Bubble Test ◽

Chest X Ray ◽

The Right ◽

Pericardiophrenic Vein

We report a case of primary malposition of a PICC inserted by guidewire replacement in the emergency room. Intraprocedural tip location by intracavitary electrocardiography was not feasible because the patient had atrial fibrillation; intraprocedural tip location by ultrasound (using the so-called “bubble test”) showed that the tip was not in the superior vena cava or in the right atrium. A post-procedural chest X-ray confirmed the malposition but could not precise the location of the tip. A CT scan (scheduled for other purposes) finally visualized the tip in a very unusual location, the left pericardiophrenic vein.

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Inadvertent Catheterization of the Ascending Lumbar Vein

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.28.3.179 ◽

2009 ◽

Vol 28 (3) ◽

pp. 179-183 ◽

Cited By ~ 9

Author(s):

Carol Trotter

Keyword(s):

Contrast Material ◽

Spinal Column ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Contrast Injection ◽

Venous Plexus ◽

Central Venous ◽

X Ray ◽

Lumbar Vein ◽

Ascending Lumbar Vein

A NUMBER OF SERIOUS COMPLICATIONS can arise from malpositioned central venous catheters (CVCs), including cardiac tamponade and perforation, pleural effusions, and infusion into the vertebral venous system anywhere along the spinal column. Figure 1 is an x-ray of a premature infant taken after insertion of a 2.0 Silastic peripherally inserted central catheter (PICC), demonstrating the catheter entering the left ascending lumbar vein (ALV). Routine contrast injection of 0.3 mL of iothalamate meglumine 60 percent (Conray, Covidien Imaging Solutions, Hazelwood, Missouri) at the time of the PICC-placement film demonstrated that the contrast material extended into the vertebral venous plexus. The catheter was immediately withdrawn before intravenous fluid was administered, and the infant experienced no complications.

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Radiographic aspects of acute community-acquired bacterial pneumonia and pulmonary tuberculosis in children

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211931 ◽

2021 ◽

Author(s):

Rivo Lova Herilanto Rakotomalala ◽

Harimino Mireille Rakotondravelo ◽

Andrianina Harivelo Ranivoson ◽

Annick Lalaina Robinson

Keyword(s):

Community Acquired Pneumonia ◽

University Hospital ◽

Radiographic Images ◽

X Ray ◽

Male Predominance ◽

Mother And Child ◽

Chest X Ray ◽

The Right ◽

The University ◽

Tuberculosis In Children

Background: The etiological diagnosis of pneumonia is often difficult because of the impossibility of microbiological confirmation most of the time. Therefore, chest X-ray is still essential for a positive diagnosis and etiological orientation. The main objective of our study was to describe the radiographic aspects of acute community-acquired pneumonia and tubercular pneumonia in children.Methods: This was a descriptive retrospective study conducted at the university hospital mother and child of Tsaralalana from January 1st to July 31st, 2017.Results: Sixty-nine cases of pneumonia were included, including 13 cases of TB pneumonia and 46 cases of acute community-acquired pneumonia. The average age was 36.68 months with a male predominance. Clinically, respiratory functional signs predominated in both cases. Alteration in general condition was mainly observed in tubercular pneumonia (26.08%). Alveolar syndromes were present in 43.47% of TB pneumonias and 36.94% of acute community-acquired pneumonia. With regard to the radiographic images, alveolar involvement was common to both types of pneumonia; the nodular image was present in 8.69% of the tubercular pneumonias and 2.17% of the acute community-acquired pneumonia; the cavity image was present only in the tubercular pneumonia (p=0.04); the right-sided location predominated in both cases.Conclusions: X-ray images were common to both TB pneumonia and acute community-acquired pneumonia; some images were specific to TB pneumonia. However, the etiologic orientation of pneumonia is based on a combination of epidemiologic, clinical, and radiographic evidence.

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Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

The Journal of Vascular Access ◽

10.1177/1129729818765057 ◽

2018 ◽

Vol 19 (6) ◽

pp. 609-614 ◽

Cited By ~ 6

Author(s):

Soshi Nakamuta ◽

Toshihiro Nishizawa ◽

Shiori Matsuhashi ◽

Arata Shimizu ◽

Toshio Uraoka ◽

...

Keyword(s):

Success Rate ◽

Detection Rate ◽

Ultrasound Guidance ◽

Catheter Placement ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Ultrasound Guided ◽

Peripherally Inserted Central Catheters ◽

X Ray ◽

Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

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Value of Preoperative Chest X-ray Examinations in Children

PEDIATRICS ◽

10.1542/peds.60.5.669 ◽

1977 ◽

Vol 60 (5) ◽

pp. 669-672

Author(s):

Shashikant M. Sane ◽

Robert A. Worsing ◽

Cornelius W. Wiens ◽

Rajiv K. Sharma

Keyword(s):

Prospective Study ◽

Pediatric Patients ◽

Anesthetic Technique ◽

Chest Film ◽

X Ray ◽

Patients Âgés ◽

Chest X Ray ◽

A Prospective Study ◽

Preoperative Chest

To assess the value of routine preoperative chest x-ray films in pediatric patients, a prospective study of 1,500 patients, ages newborn to 19 years, was undertaken. Of all the patients, 7.5% demonstrated at least one roentgenographic abnormality, with 4.7% of the patients demonstrating a totally unsuspected significant roentgenographic anomaly. In 3.8% of the patients, surgery was either postponed or cancelled or the anesthetic technique was altered as a result of the roentgenographic finding. It is believed that the routine preoperative chest film is justified if the film is evaluated before surgery and the results clinically followed up.

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Can We Screen Febrile Children for Pneumonia and/or Bacteremia Without Chest X-ray Films and Blood Cultures?

PEDIATRICS ◽

10.1542/peds.61.2.332a ◽

1978 ◽

Vol 61 (2) ◽

pp. 332-333

Author(s):

Henry M. Feder

Keyword(s):

Young Children ◽

Prospective Study ◽

False Negative ◽

Blood Cultures ◽

Chest Roentgenogram ◽

Negative Group ◽

X Ray ◽

Chest X Ray ◽

Wbc Count ◽

A Prospective Study

McCarthy et al. in their article "Temperature Greater Than or Equal to 40 C in Children Less Than 24 Months of Age: A Prospective Study" (Pediatrics 59:663, May 1977) recommend using both WBC count (≥ 15,000/cu mm) and ESR (≥ 30 mm/hr) for screening febrile young children for pneumonia or bacteremia. If either is elevated they suggest doing blood cultures and taking a chest roentgenogram. However, in 25% of their patients with bacteremia and 42% of their patients with pneumonia neither WBC count nor ESR was elevated, leaving a sizable false-negative group.

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