European Radiology

, Volume 27, Issue 7, pp 2843–2849 | Cite as

Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement

  • Frédéric Glauser
  • Stephane Breault
  • Fabio Rigamonti
  • Charalampos Sotiriadis
  • Anne-Marie Jouannic
  • Salah D. QanadliEmail author



Peripherally inserted central catheter (PICC) use continues to increase, leading to the development of a blind bedside technique (BST) for placement. The aim of our study was to compare the BST with the fluoroscopically guided technique (FGT), with specific regard to catheter tip position (CTP).

Materials and methods

One hundred eighty patients were randomized to either the BST or the FGT. All procedures were done by the same interventional team and included postprocedural chest X-ray to assess CTP. Depending on the international guidelines for optimal CTP, patients were classified in three types: optimal, suboptimal not needing repositioning, and nonoptimal requiring additional repositioning procedures. Fisher’s test was used for comparisons.


One hundred seventy-one PICCs were successful inserted. In the BST groups, 23.3% of placements were suboptimal and 30% nonoptimal, requiring repositioning. In the FGT group, 5.6% were suboptimal and 1.1% nonoptimal. Thus, suboptimal and nonoptimal CTP were significantly lower in the FGT group (p < 0.001).


Tip malposition rates are high when using blind BST, exposing the patient to an increased risk of deep venous thrombosis and catheter malfunction. Using the FGT or emerging technologies that could help tip positioning are recommended, especially for long-term indications.

Key points

Bedside and fluoroscopy guided techniques are commonly used for PICC placement.

Catheter malposition is the major technical issue with the bedside technique.

Catheter malposition occurred in 53% of patients with the bedside technique.


Peripherally inserted central catheters Tip malposition Fluoroscopically guided technique Blind bedside technique Intensive care unit 



Peripherally inserted central catheters


Blind bedside technique


Fluoroscopically guided technique


Catheter tip position


Centrally inserted venous catheters


Superior vena cava


Cavoatrial junction


Intensive care unit



The scientific guarantor of this publication is Salah Dine Qanadli. The authors of this manuscript declare relationships with the following companies: Salah Dine Qanadli was a consultant for C. R Bard Inc. during the last 3 years. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Frédéric Glauser
    • 1
  • Stephane Breault
    • 2
  • Fabio Rigamonti
    • 3
  • Charalampos Sotiriadis
    • 2
  • Anne-Marie Jouannic
    • 2
  • Salah D. Qanadli
    • 2
    Email author
  1. 1.Department of AngiologyUniversity Hospital of LausanneLausanneSwitzerland
  2. 2.Department of Radiology, Cardio-Thoracic and Vascular UnitUniversity Hospital of LausanneLausanneSwitzerland
  3. 3.Division of CardiologyGeneva University HospitalsGenevaSwitzerland

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