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).

Persistent Left Superior Vena Cava

2014 ◽  
Vol 19 (2) ◽  
pp. 84-85 ◽  
Author(s):  
Vicki L. Mabry ◽  
Anne T. Mancino ◽  
Sheila Cox Sullivan
Keyword(s):  
Superior Vena Cava ◽  
Chest Radiograph ◽  
Incidental Finding ◽  
Superior Vena ◽  
Vena Cava ◽  
Vascular Anomaly ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena

Abstract This is a case report of an incidental diagnosis of persistent left superior vena cava (PLSVC). The diagnosis was suspected after a peripherally inserted central catheter (PICC) was placed and a postinsertion chest radiograph was conducted. PLSVC is a vascular anomaly that is usually diagnosed as an incidental finding. Here, we discuss the tests performed to confirm the diagnosis and the 3 variants of PLSVC. Nurses who place PICCs are likely to run across this abnormality on postinsertion chest radiograph and knowing the diagnostic test to order to confirm the diagnosis is key in expediting patient care.

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

2008 ◽  
Vol 13 (4) ◽  
pp. 179-186 ◽  
Author(s):  
Mauro Pittiruti ◽  
Giancarlo Scoppettuolo ◽  
Antonio La Greca ◽  
Alessandro Emoli ◽  
Alberto Brutti ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
X Ray ◽  
Non Invasive ◽  
Catheter Tip

Abstract Two preliminary studies were conducted to determine feasibility of using the electrocardiography (EKG) method to determine terminal tip location when inserting a peripherally inserted central catheter (PICC). This method uses the guidewire inside the catheter (or a column of saline contained in the catheter) as an intracavitary electrode. The EKG monitor is then connected to the intracavitary electrode. The reading on the EKG monitor reflects the closeness of the intracavitary electrode (the catheter tip) to the superior vena cava (SVC). The studies revealed that the EKG method was extremely precise; all tips placed using the EKG method and confirmed using x-ray were located in the superior vena cava. In conclusion, the EKG method has clear advantages in terms of accuracy, cost-effectiveness, and feasibility in conditions where x-ray control may be difficult or expensive to obtain. The method is quite simple, easy to learn and to teach, non-invasive, easy to reproduce, safe, and apt to minimize malpositions due to failure of entering the SVC.

Electrocardiogram-Guided Peripherally Inserted Central Catheter Tip Confirmation Using a Standard Electrocardiogram Machine and a Wide-Mouth Electrocardiogram Clip Compared with Traditional Chest Radiograph

2016 ◽  
Vol 21 (1) ◽  
pp. 44-54 ◽  
Author(s):  
Yvonne K. Cales ◽  
Jennifer Rheingans ◽  
Janet Steves ◽  
Mary Moretti
Keyword(s):  
Superior Vena Cava ◽  
Chest Radiograph ◽  
Superior Vena ◽  
Vena Cava ◽  
P Wave ◽  
Control Group ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Wide Mouth ◽  
Experimental Group

Abstract Objective: The purpose of this institutional review board-approved, single-blinded, randomized controlled trial was to evaluate the effectiveness of bedside peripherally inserted central catheter (PICC) tip placement using a nonproprietary electocardiogram (EKG) machine and wide-mouth EKG clip connected to the right arm lead and PICC guide wire. The hospital site in this study was an 800-bed community, nonacademic, Magnet hospital in the southeastern United States. Methods: All patients who provided consent and were eligible for bedside PICC insertion were randomly assigned to either standard PICC insertion or standard PICC insertion plus EKG guidance. Placement was identified by observing for P wave changes, which indicated PICC tip location in relationship to the sinoatrial node in the superior vena cava. After the PICC lines were placed, 2 radiologists blinded to treatment assignment independently reviewed confirmatory chest radiographs. De-identified data were collected and analyzed. Results: One hundred eighty-seven patients participated in this study. Of all patients, 94.6% had a baseline rhythm with a discernable P wave. The time to insert the PICC while using EKG guidance increased by a mean difference of 9 minutes (P = .001). The time to notification of the floor nurse that the PICC was read by a radiologist and ready to use for infusions was not significant between groups. In the control group, 91.8% of PICC lines were placed to completion at the bedside vs 90.2% in the experimental group (P = .710). PICCs placed with EKG guidance were successfully placed with the first attempt or 1 pass (89%; n = 91) vs PICCs placed without EKG guidance (75%; n = 63; P = .01). Of the control group, 40% (n = 34) and of the experimental group, 48% (n = 49) had PICC lines placed within 1.5 cm of the sinoatrial junction. Of the control group, 53% (n = 45) and of the experimental group, 65% (n = 66) had PICC lines placed within 1.5 cm of the sinoatrial junction to 3.0 cm above the sinoatrial junction (P = .10). Of the control group, 64.8% (n = 55) and of the experimental group, 82.2% (n = 84) had PICC lines placed within 1.5 cm of the sinoatrial junction to 6.0 cm above the sinoatrial junction (P =.3). Of the control group, 7.1% (n = 6) and of the experimental group, 2.9% (n = 3) had PICC lines placed 6.1 cm or more above the sinoatrial junction. Of the control group, 18.8% (n = 16) and of the experimental group, 8.8% (n = 9) had PICC lines placed too deep in the superior vena cava and below 1.6 cm (P < .05). PICCs inserted with or without EKG guidance statistically had the same amount of chest radiograph images performed (P =.083). Three groups reviewed the chest radiographs to determine the PICC tip location and they agreed to the location 82% of the time and a significant positive correlation between all 3 groups existed. The PICC Team subjectively identified 22 patients as obese. No statistical significance was realized among patients not identified as obese vs those identified as obese. Conclusions: The data revealed that the control and experimental groups were equally distributed for baseline demographic characteristics such as sex and age. Importantly, it was determined that 94% of participants had a discernable P wave and were candidates for the use of EKG guidance. The time to insert a PICC line at bedside with the use of EKG guidance increased the procedure time by a mean of 9 minutes; however, the ultimate infiuence on patient care resulted in a savings of 67 minutes after factoring in an average of 76 minutes for radiograph confirmation. Complications and the need to reposition PICC lines were not found to be significant or vastly different or improved with or without the use of EKG guidance. PICC lines placed with the use of EKG guidance were significantly unlikely to be repositioned. Lastly, it was found that obesity did not play any particular role. Based on these findings, the facility determined that EKG guidance is effective and its use was implemented for all bedside PICC placements in which a P wave was discernable.

Peripherally inserted central catheter malposition to a persistent left superior vena cava: A successful case to leave the catheter till the end of chemotherapy

2020 ◽  
pp. 112972982093820
Author(s):  
Qi Li ◽  
Yuxiu Liu ◽  
Min Wang ◽  
Zhongjie Yu ◽  
Yufang Gao
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Catheter Insertion ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Catheter Tip ◽  
Tip Position

Persistent left superior vena cava is rare and asymptomatic and is usually discovered incidentally during or after insertion of a central venous catheter. There is uncertainty as to whether or not the catheter should be removed after its malposition resulting in persistent left superior vena cava. We reported an unusual case of a breast cancer patient with a persistent left superior vena cava detected after a peripherally inserted central catheter insertion. The patient had undergone a modified radical mastectomy and needed to insert a peripherally inserted central catheter for chemotherapy. After the peripherally inserted central catheter insertion, the chest X-ray and computed tomography showed that the catheter was located in the persistent left superior vena cava. After an assessment of the persistent left superior vena cava and the catheter tip position, the peripherally inserted central catheter remained in the persistent left superior vena cava for further therapy. To ensure the integrity of the catheter, special follow-ups and tip position observations were carried out. The peripherally inserted central catheter was safe until the end of chemotherapy with no complications. Although the peripherally inserted central catheter tip was located in persistent left superior vena cava, given that the persistent left superior vena cava coexisted with a right superior vena cava with the similar lumen, the peripherally inserted central catheter could be used normally under strict attention.

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.

scholarly journals Persistent Left Superior Vena Cava Identified during Peripherally Inserted Central Catheter Line Placement

2019 ◽  
Vol 5 (02) ◽  
pp. 64-66
Author(s):  
Arvind Borde ◽  
Vivek Ukirde
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Left Superior Vena Cava ◽  
Anatomical Variant ◽  
Persistent Left Superior Vena ◽  
Line Placement ◽  
Picc Line

Abstract Introduction A persistent left superior vena cava (SVC) is found in 0.3 to 0.5% of the general population. It is seen in up to 10% of the patients with a congenital cardiac anomaly, being the most common thoracic venous anomaly, and is usually asymptomatic. Being familiar with such anomaly could help clinicians avoid complications during the placement of central lines, Swan-Ganz catheters, peripherally inserted central catheter (PICC) lines, dialysis catheters, defibrillators, and pacemakers. Case Presentation We describe a case of persistent left SVC which was noted after placement of a PICC line. A 5-year-old male child was hospitalized for evaluation and management of leukemia. He required PICC line placement for chemotherapy. He was noted to have a persistent left SVC during the procedure under fluoroscopic guidance and subsequently correct placement of PICC line in right SVC. Discussion This anatomical variant can pose iatrogenic risks if the clinician does not recognize it. A central catheter that tracks down the left mediastinal border may also be in the descending aorta, internal thoracic vein, superior intercostal vein, pericardiophrenic vein, pleura, pericardium, or mediastinum. Conclusion Our case is significant because the patient was diagnosed with double SVC on table only followed by the placement of PICC line into the right SVC. This case strongly demonstrates the importance of knowing the thoracic venous anomalies.

The Use of CT Imaging Technology in Peripherally Inserted Central Catheter

2021 ◽  
Vol 11 (1) ◽  
pp. 114-119
Author(s):  
Ying Wu ◽  
Guohua Huang ◽  
Qiufeng Li ◽  
Jinai He
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Ct Imaging ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Imaging Technology ◽  
X Ray ◽  
The Right

Objective: The objective is to explore the application of computed X-ray tomography (CT) imaging technology in peripherally inserted central catheter (PICC), and to propose a more effective method for PICC catheterization. Method: In this study, 69 subjects are divided into the observation group (X-ray and CT) and the control group (X-ray). The guiding effect of CT images on PICC tube placement in complex cases is compared. In this study, CT localization of the superior vena cava–caval-atrial junction (CAJ) is used as the gold standard. The position relationship of carina-CAJ and carina-PICC catheter tip is measured and analyzed by CT image and chest radiography (CXR) image, providing scientific basis for PICC tip imaging. Results: After this study, the tip of the catheter should be 1/3 of the middle and lower part of the superior vena cava, about 3 cm above the junction of the right atrium and the superior vena cava, and in the upper part of the diaphragm of the inferior vena cava, so that it cannot enter the right ventricle or the right atrium. The best position of the tip of the catheter is near the junction of the superior vena cava and the right atrium. The average vertical distance between the tracheal carina and CAJ is 4.79 cm. Conclusion: CT and X-ray examination can effectively determine the location of the tip of PICC catheter in cancer chemotherapy patients, but the clarity of X-ray examination is missing. It is suggested to adopt CT examination, and further adopt and promote it.

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