Validation of the PICC length prediction formula based on anteroposterior chest radiographs for bedside ultrasound-guided placement

Abstract

This study aimed to validate the accuracy of the peripherally inserted central catheter (PICC) length prediction formula using only anteroposterior chest radiographs (AP-CXR) and the technical feasibility of bedside ultrasound-guided PICC placement. This study included 156 Asian adult patients who underwent bedside PICC placement at three hospitals from September 2021 to March 2022. The shortest straight-line distance from the cubital crease to the puncture point (CP) was measured first. Using the formula of a previous study, the CP + estimated PICC length (eCL) was calculated with the parameters measured on AP-CXR. The formula was as follows: 19.409 + 0.424 × (MHTD, maximal horizontal thoracic diameter) + 0.287 × (CL, clavicle length) + 0.203 × (DTV, distance of thoracic vertebrae) + (2VBUs, two vertebral body units below the carina inferior border) (if from the left, 3.063cm was added; if female, 0.997cm was subtracted). Catheters were pretrimmed according to calculated eCL prior to the procedure. Technical success was evaluated, and the validation success of catheter length prediction was classified according to the catheter tip position as follows: optimal position or suboptimal position. Technical success was achieved in 153 cases (98.1%). Evaluation of validation success revealed that the position was “optimal” in 108 cases (70.6%) and “suboptimal” in 45 cases (29.4%). There was no validation failure. There was no case where the catheter was inserted too deep as to wedge into the right atrial wall. In conclusion, the PICC could be positioned accurately using the formula based on only AP-CXR. Furthermore, this bedside procedure was technically feasible.

Development and validation of an updated PICC length prediction formula based on anteroposterior chest radiographs for the ultrasound-guided bedside placement

“…This study introduced an updated new formula for predicting PICC length using AP-CXRs, the most common chest radiograph in clinical settings. This formula achieved an optimal length prediction rate of 90.1%, which is more accurate than that using previous Park et al's formula of 70.2% validated by Cho et al [10,13]. Although the appropriate catheter tip position is still debated, the CAJ area is considered the most ideal on the premise that it is not wedging to the RA wall [11,[19][20][21][22].…”

“…Compared with a central venous catheter via the internal jugular or subclavian vein, PICC insertion carries a low risk of pleuropulmonary damage or a local hemorrhage or hematoma [15], so this technique is performed worldwide. The placement of a PICC at the bedside has become increasingly common in various clinical settings [6,13,[16][17][18]. However, determining the length of the catheter is one of the most challenging aspects of a successful bedside PICC procedure.…”

“…The prediction success of catheter length was evaluated according to the estimated catheter tip position compared to the actual catheter tip PLOS ONE position, comparing between eCL and aCL; the results were classified as optimal or suboptimal (Fig 3). This criterion was set to be the same as that of Cho et al's study [13], which validated the initial formula of Park et al [10]. The upper margin of the superior vena cava (SVC) was designated at the right tracheobronchial angle on the AP-CXR following Aslamy et al's study [14].…”

A Comparison of In Vitro Measurement and Ultrasound for Peripherally Inserted Central Catheter Placement in Premature Infants: A Before-and-After Self-Controlled Prospective Study

“…The growing demand for precise, non-intrusive, and efficient PICC positioning in clinical settings makes the broad, less accurate approach of IVM increasingly inadequate [ 20 , 21 ]. In contrast, US, with its bedside visualization and precision, addresses these limitations, offering a convenient, repeatable, and accurate method for real-time catheter tip positioning [ 22 , 23 ].…”

A nurse-inserted peripherally inserted central catheter program in general pediatrics: a single-center experience

“…Even though the complication rate in overall cases was not remarkably high, there is still large room for improvement. The following approaches could be carefully reviewed in future cases: ultrasound for guiding PICC insertion [ 25 , 26 ], routine daily heparin flushing in 1.9Fr cases [ 27 ], novel approaches for guiding PICC insertion, such as intracavitary electrocardiogram etc. [ 28 ].…”