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

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          Abstract

          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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          Most cited references25

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          Complications of central venous catheters: internal jugular versus subclavian access--a systematic review.

          Martin Tramèr, Bernhard Walder, Sibylle Ruesch (2002)
          To test whether complications happen more often with the internal jugular or the subclavian central venous approach. Systematic search (MEDLINE, Cochrane Library, EMBASE, bibliographies) up to June 30, 2000, with no language restriction. Reports on prospective comparisons of internal jugular vs. subclavian catheter insertion, with dichotomous data on complications. No valid randomized trials were found. Seventeen prospective comparative trials with data on 2,085 jugular and 2,428 subclavian catheters were analyzed. Meta-analyses were performed with relative risk (RR) and 95% confidence interval (CI), using fixed and random effects models. In six trials (2,010 catheters), there were significantly more arterial punctures with jugular catheters compared with subclavian (3.0% vs. 0.5%, RR 4.70 [95% CI, 2.05-10.77]). In six trials (1,299 catheters), there were significantly less malpositions with the jugular access (5.3% vs. 9.3%, RR 0.66 [0.44-0.99]). In three trials (707 catheters), the incidence of bloodstream infection was 8.6% with the jugular access and 4.0% with the subclavian access (RR 2.24 [0.62-8.09]). In ten trials (3,420 catheters), the incidence of hemato- or pneumothorax was 1.3% vs. 1.5% (RR 0.76 [0.43--1.33]). In four trials (899), the incidence of vessel occlusion was 0% vs. 1.2% (RR 0.29 [0.07-1.33]). There are more arterial punctures but less catheter malpositions with the internal jugular compared with the subclavian access. There is no evidence of any difference in the incidence of hemato- or pneumothorax and vessel occlusion. Data on bloodstream infection are scarce. These data are from nonrandomized studies; selection bias cannot be ruled out. In terms of risk, the data most likely represent a best case scenario. For rational decision-making, randomized trials are needed.
          Article 0 comments Cited 136 times – based on 0 reviews     Review now
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            Central venous catheter tip position: a continuing controversy.

            M Vesely (2003)
            There is continuing debate among physicians, nurses, and federal regulatory agencies regarding the correct position for the tip of a central venous catheter. The traditional approach has been to place the catheter tip within the superior vena cava. However, many interventionalists believe that the performance and durability of the catheter will be improved by positioning the catheter tip within the upper right atrium. Recently, this variability in clinical practice has become an increasingly divisive issue among physicians who insert these catheters and nurses who use them. This article is intended to elucidate the controversial issues and provide a brief review of the extensive literature on this important topic.
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              Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US.

              V Bassot, P Bonfils, A. Luciani … (2001)
              This prospective study extending for more than 3 years had two objectives: (a) to use Doppler ultrasonography (US) to estimate the incidence of asymptomatic catheter-related upper extremity deep venous thrombosis (DVT) in a large population and (b) to study the effect of the catheter position as an individual risk factor for catheter-related DVT. Between October 1995 and June 1998, a total of 145 patients who had oropharyngeal tract cancer and who were fitted with the same totally implantable central venous catheters (CVCs) were included in the study. Follow-up included (a) estimation of the position of each catheter tip on a chest radiograph obtained immediately after surgery and (b) regular monthly Doppler US screening for catheter-related DVT. Seventeen patients developed catheter-related DVT; 13 of them were asymptomatic. The mean interval between CVC implantation and detection of thrombosis was 42.2 days. Correct positioning of the distal catheter tip was associated with a significantly lower rate of catheter-related DVT. Only five of 87 patients with a correctly positioned distal catheter tip (ie, either in the superior vena cava or at the junction between the right atrium and the superior vena cava) developed thrombosis, compared with 12 of 26 patients with a misplaced catheter (P <.001). The side on which the CVC was implanted did not influence the catheter-related DVT rate. The rate of asymptomatic catheter-related DVT is high and could be lowered with correct initial CVC positioning.
              Article 0 comments Cited 41 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acute Crit Care
                Journal ID (iso-abbrev): Acute Crit Care
                Journal ID (publisher-id): ACC
                Title: Acute and Critical Care
                Publisher: Korean Society of Critical Care Medicine
                ISSN (Print): 2586-6052
                ISSN (Electronic): 2586-6060
                Publication date (Print): February 2020
                Publication date (Electronic): 11 February 2020
                Volume: 35
                Issue: 1
                Pages: 31-37
                Affiliations
                [1 ]Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
                [2 ]Division of Vascular and Transplant Surgery, Department of Nursing, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
                [3 ]Division of Vascular and Transplant Surgery, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
                [4 ]Division of Vascular and Transplant Surgery, Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Author notes
                Corresponding author Hyangkyoung Kim Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6744 Fax: +82-2-595-2822 E-mail: cindycrow7456@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-5984-9493
                http://orcid.org/0000-0003-1912-5914
                http://orcid.org/0000-0003-3032-1000
                http://orcid.org/0000-0003-4990-5727
                http://orcid.org/0000-0002-2021-815X
                http://orcid.org/0000-0002-1016-5664
                http://orcid.org/0000-0002-5710-7090
                http://orcid.org/0000-0002-5543-6755
                Article
                Publisher ID: acc-2019-00731
                DOI: 10.4266/acc.2019.00731
                PMC ID: 7056959
                PubMed ID: 32131579
                SO-VID: bf672541-e1bf-44ba-92c0-546583ee2661
                Copyright © Copyright © 2020 The Korean Society of Critical Care Medicine
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 October 2019
                Date revision received : 11 November 2019
                Date accepted : 17 January 2020
                Categories
                Subject: Original Article
                Subject: Surgery

                Keywords: catheterization, peripheral,catheterization, central,vascular access devices
                Data availability:
                Keywords: catheterization, peripheral, catheterization, central, vascular access devices

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