Spontaneous correction of misplaced peripherally inserted central catheters

Abstract

The purpose of the present study was to examine a new protocol involving the spontaneous correction of the misplaced tip of a peripherally inserted central catheter (PICC). Patients with PICCs misplaced in the jugular or contralateral subclavian veins were recruited. All patients underwent chest X-ray (CXR) after 3 days. In addition, those whose PICC tip still was misplaced and received another CXR after 4 days. The functions of the catheters, the subjective feelings of the patients, and local symptoms of the neck and upper anterior chest wall were recorded. Among 866 patients who had PICCs, we observed 22 PICC tips misplaced in the jugular, 3 tips misplaced in the contralateral subclavian vein, and 7 tips misplaced in other locations, which was confirmed by CXR. A total of 22 PICC tips automatically returned to the superior vena cava, which included all 3 tips in the contralateral subclavian vein and 19 tips in the jugular vein. All catheters functioned normally, and the patients had no complaints. In addition, we observed no local symptoms of the neck and upper anterior chest wall. For patients experiencing a PICC misplaced in the jugular and contralateral subclavian veins, there is no need to manually replace. In addition, the function of the catheter can remain normal.

A feasible and safe standardized protocol for ultrasound and intracavitary electrocardiogram-based tip navigation and tip location during placement of peripherally inserted central catheters

“…After specific P waves (P-wave amplitude 50%–80% of QRS) were observed, to confirm venous reflux and flushing the catheter with saline, the PICC is fixed to the skin. 20 Next take a X-ray to judge the distance between the tip of the catheter and the tracheal carina.…”

“…When P-wave amplitude 50%–80% of QRS appears, confirm venous reflux and flushing the catheter with saline, then fixed on the skin. 20 Nevertheless, patients without specific P waves should be judged on previous ultrasound imaging results of none malposition of catheter, then confirm venous reflux and flushing the catheter with saline, the PICC is fixed to the skin. 20 Next take a X-ray to judge the distance between the tip of the catheter and the tracheal carina.…”

“…4,16 ECG is proved to be a safe and effective technique to confirm tip location of PICCs, 4,10,17 but it is suitable for patients with surface P waves (99.3%) and rate of tip malposition is (3.8%). 6,[18][19][20] Ultrasound-based tip location may be very useful when IC-ECG cannot be performed.…”

“…In our department, ultrasound-based tip navigation is utilized to observe the catheter image and its trend. 20,21 After the judgment of ultrasonic technology without malposition of catheter, ECG is the second tip navigation and tip location of the catheter. Use with ultrasound and intracavitary electrocardiogram-based tip navigation without extra expense, and saves time.…”

<p>Nurses’ Attitudes and Knowledge of Peripherally Inserted Central Catheter Maintenance in Primary Hospitals in China: A Cross-Sectional Survey</p>

“…The peripherally inserted central catheter (PICC) has been widely used in prolonged intravenous therapy and parenteral nutrition since it was introduced to China 1 – 5 due to its clinical advantages, such as long indwelling time, reduced vascular damage, and convenient placement and removal. 6 – 8 However, like other central venous access devices, PICCs are associated with several complications, including thrombosis 4 , 5 , 9 – 11 local infection, 4 bloodstream infection, 9 , 10 , 12 occlusion, 4 , 5 , 8 , 9 , 13 and breakage.…”