X(-rays) sometimes mark the spot: A case of occult central venous catheter embolization

2019 ◽  
Vol 21 (5) ◽  
pp. 795-798
Author(s):  
Marco Baciarello ◽  
Giada Maspero ◽  
Umberto Maestroni ◽  
Giuseppina Palumbo ◽  
Valentina Bellini ◽  
...  
Keyword(s):  
Emergency Department ◽  
Venous Catheter ◽  
Chest Radiographs ◽  
X Rays ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Catheter Embolization ◽  
Asymptomatic Patients ◽  
Catheter Tip ◽  
Routine Chest

Introduction: Breakage and fragment embolization is a rare but feared complication of peripherally inserted central catheter use. While chest radiographs are no longer the gold standard for determining peripherally inserted central catheter tip position, their use in diagnosing complications is still warranted. We report a case of occult catheter embolization discovered by routine chest X-ray. Case Description: A patient with a right brachial vein peripherally inserted central catheter was admitted to our Emergency Department for palpitations and dyspnea. The peripherally inserted central catheter was not visible at presentation, and she was unclear as to what had happened; she left the Emergency Department before workup was performed. Catheter embolization was discovered upon implantation of a new peripherally inserted central catheter. Conclusion: Although routine chest radiographs are no longer necessary after peripherally inserted central catheter implantation, they are in diagnosing peripherally inserted central catheter–related complications even in asymptomatic patients. We discuss their use and the possible role of securement devices in preventing some instances of catheter embolization.

scholarly journals An accuracy study of the Intracavitary Electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Lian-juan Zhou ◽  
Hong-zhen Xu ◽  
Mei-fang Xu ◽  
Yan Hu ◽  
Xiao-Fang Lou
Keyword(s):  
Logistic Regression ◽  
Lower Extremity ◽  
Dynamic Change ◽  
Multivariate Logistic Regression Analysis ◽  
X Rays ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
P Waves ◽  
Catheter Tip ◽  
Accuracy Study

AbstractObjectiveTo explore the clinical application of the intracavitary electrocardiogram (IC-ECG) guided Peripherally Inserted Central Catheter (PICC) tip placement among neonates.Backgroundthe ECGs of neonates are difficult to perform and their wave shapes are of doubtful accuracy due to various interfering factorsMethod115 neonates were admitted to perform PICC guided by IC-ECG. Logistic regression was performed to analyze all possible influencing factors of the accuracy from the tip placement. The puncture site of the PICC, gestational age, height, weight, basal P/R amplitude and positioning P/R amplitude might be related to the accuracy of IC-ECG location.ResultThe accuracy in the lower extremity was higher than that in the upper extremity. Multivariate logistic regression analysis showed that the weight (Odds Ratio (OR)=1.93, 95%Confidence Interval(CI):1.06-3.50) and positioning P/R amplitude (OR=32.33, 95%CI: 2.02-517.41) are statistically significant risks to the accuracy PICC tip placement.ConclusionsPossible methods to improve the accuracy might be Catheterizing through lower extremity, keeping the neonates calm, enhancing the electrocardiogram signal and strengthening technical training. Therefore it is practical to perfrom a tip placement by the dynamic change in the P waves from an electrocardiogram (ECG) guided PICC among neonates and as reliable as using X-rays.

278 PERIPHERALLY INSERTED CENTRAL CATHETER TIP LOCATION IN NEONATES

2005 ◽  
Vol 53 (1) ◽  
pp. S127.1-S127
Author(s):  
P. Fliman ◽  
R. deRegnier ◽  
M. DeUngria ◽  
R. Shore ◽  
R. Steinhorn
Keyword(s):  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Catheter Tip

scholarly journals Cateter central de inserção periférica e dissecção venosa em bebês: estudo descritivo

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Keline Soraya Santana Nobre ◽  
Maria Vera Lúcia Moreira Leitão Cardoso ◽  
Juliana Lopes Teixeira ◽  
Márcia Maria Coelho Oliveira Lopes ◽  
Fernanda Cavalcante Fontenele
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Quantitative Study ◽  
Neonatal Unit ◽  
Northeastern Brazil ◽  
Maternity Unit ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Catheter Tip

Aim:  analyze  the  use  of  peripherally  inserted  central  catheter  in terms of the aspects of technique, positioning and maintenance, as well as the influence on the number of venous dissections in hospitalized infants in a neonatal unit. Method: descriptive,  retrospective,  quantitative  study,  in  reference  maternity  unit  of  a  city  in northeastern  Brazil.  Sample  composed  of  1,599  peripherally  inserted  central  catheter insertions in 1,204 infants during the years 2006 to 2013. Instruments were used that recorded  aspects  of  the  insertion  of  peripherally  inserted  central  catheter  and  venous dissection.  Results:  most  babies  were  premature,  of  low  birth  weight  and  male.  The veins  of  the  cubital  region  were  the  most  punctured  with  insertion  success  until  the fourth  puncture.  The  central  positioning  of  the  catheter  tip predominated,  with  a permanency  time  between  11  and  20  days,  removing  it  at  the  end  of  the  treatment. Over  the  years,  the  number  of  venous  dissections  was  inversely  proportional  to  the insertion  of  peripherally  inserted  central  catheter.  Conclusion:  this  transvenous  device was  shown  to  be  important  for  the  treatment  of  hospitalized  newborns,  favoring reduction of venous dissections.

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

2020 ◽  
Vol 21 (5) ◽  
pp. 732-737
Author(s):  
Chunli Liu ◽  
Dingbiao Jiang ◽  
Tao Jin ◽  
Chuanyin Chen ◽  
Ruchun Shi ◽  
...  
Keyword(s):  
Upright Position ◽  
Body Posture ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Posture Change ◽  
Body Change ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Chinese Cancer Patients

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p = 0.009) and height ( p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Repositioning of malpositioned peripherally inserted central catheter lines with the use of intracavitary electrocardiogram: A pediatric case series

2019 ◽  
Vol 21 (2) ◽  
pp. 259-264 ◽  
Author(s):  
Mark D Weber ◽  
Adam S Himebauch ◽  
Thomas Conlon
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Right Atrial ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Case Presentation ◽  
Central Lines ◽  
Catheter Tip ◽  
Standard Radiographs

Introduction: Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs. Case presentation: A case series of four patients will be discussed. The first three patients had peripherally inserted central catheter tips that were initially appropriately positioned but had later peripherally inserted central catheter tip migration. The use of intracavitary electrocardiogram was able to confirm the appropriate repositioning of the peripherally inserted central catheters without the need for serial radiographs. The fourth patient had several central lines in place, which led to difficulty in identifying the peripherally inserted central catheter tip location. The use of intracavitary electrocardiogram confirmed proper positioning of his peripherally inserted central catheter tip when standard radiographs could not provide clarity. Discussion: Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.

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

2011 ◽  
Vol 31 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Geng Tian ◽  
Bin Chen ◽  
Li Qi ◽  
Yan Zhu
Keyword(s):  
Infection Rate ◽  
Superior Vena Cava ◽  
Chest Radiograph ◽  
Superior Vena ◽  
Vena Cava ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Catheter Tip

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).

Excellent inter-observer agreement between radiologist and nurse: tracheal carina-based identification of peripherally inserted central catheter tip position

2018 ◽  
Vol 19 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Xiaoxia Zhang ◽  
Dan Jia ◽  
Nengwen Ke ◽  
Chang Liu ◽  
Lan Fu ◽  
...  
Keyword(s):  
Border Region ◽  
Observer Agreement ◽  
Central Vein ◽  
Emergency Setting ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Accurate Identification ◽  
Catheter Tip ◽  
Tip Position ◽  
Tracheal Carina

Introduction: Accurate identification of position of a central venous catheter tip is important to reduce catheter-related complications. Nevertheless, inter-observer bias limits the accuracy of traditional method for determining tip position on chest x-ray (CXR) images. The aim of this study was to explore a simple and objective method for assessing position of peripherally inserted central catheter (PICC) tip on CXR image. Methods: Tracheal carina was used as the landmark to identify positions of catheter tips. The central vein (CV) was located between 3 cm above and 4 cm below tracheal carina. The vertical distance from catheter tips to tracheal carina was measured independently by a nurse and re-assessed by a radiologist. Inter-observer agreement was expressed as percentage in agreement and kappa coefficient. Results: Six hundred and twelve CXR images of catheters taken from 612 patients were included. The inter-observer agreement between nurse and radiologist was 97.88% (kappa = 0.934) for all catheter tips evaluated, and 98.40% (kappa = 0.923) for catheter tips with regard to CV, innominate vein, and right atrium. Most discrepancies (9/13) between observers occurred when catheter tips were positioned in a border region between different anatomical parts. Conclusions: Inter-observer agreement between nurse and radiologist is excellent. Our results demonstrate that the measurement of distance between catheter tip and tracheal carina performed by a nurse provide a convenient and reliable way to determine position of PICC tip. Our study also suggests that nurses can be trained to handle PICCs, especially when properly located catheters are applied in critically ill patients during emergency setting.

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