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

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

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.

Results

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).

Conclusion

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.

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Abbreviations

PICC:

Peripherally inserted central catheters

BST:

Blind bedside technique

FGT:

Fluoroscopically guided technique

CTP:

Catheter tip position

CICV:

Centrally inserted venous catheters

SVC:

Superior vena cava

CAJ:

Cavoatrial junction

ICU:

Intensive care unit

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Acknowledgements

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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Authors and Affiliations

  1. Department of Angiology, University Hospital of Lausanne, Rue du Bugon 46, CH-1011, Lausanne, Switzerland

    Frédéric Glauser

  2. Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland

    Stephane Breault, Charalampos Sotiriadis, Anne-Marie Jouannic & Salah D. Qanadli

  3. Division of Cardiology, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland

    Fabio Rigamonti

Authors
  1. Frédéric Glauser
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  2. Stephane Breault
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  3. Fabio Rigamonti
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  4. Charalampos Sotiriadis
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  5. Anne-Marie Jouannic
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  6. Salah D. Qanadli
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Correspondence to Salah D. Qanadli.

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Glauser, F., Breault, S., Rigamonti, F. et al. Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement. Eur Radiol 27, 2843–2849 (2017). https://doi.org/10.1007/s00330-016-4666-y

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  • DOI: https://doi.org/10.1007/s00330-016-4666-y

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