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

• DOI: 10.1007/s00330-016-4666-y
• Publication Date: 2016-12-12T13:50:32Z
• Authors: Frédéric Glauser; Stephane Breault; Fabio Rigamonti; Charalampos Sotir...; Anne-Marie Jouannic; Salah D. Qanadli
• Keywords: Male; Peripherally inserted central catheters; Catheterization, Central Venous; Catheterization, Central Venous / instrumentation; Blind bedside technique; Fluoroscopy / methods; 03 medical and health sciences; Central Venous Catheters / adverse effects; 0302 clinical medicine; info:eu-repo/classification/ddc/616; Catheterization, Peripheral; Central Venous Catheters; Humans; Intensive care unit; Prospective Studies; Tip malposition; Venous Thrombosis; Catheterization, Peripheral / instrumentation; Venous Thrombosis / etiology; Middle Aged; Venous Thrombosis / diagnosis; Catheterization, Central Venous / adverse effects; 3. Good health; Fluoroscopically guided technique; Point-of-Care Testing; Fluoroscopy; Equipment Failure; Female; Follow-Up Studies

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).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.• 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.