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

Autor: Glauser F; Department of Angiology, University Hospital of Lausanne, Rue du Bugon 46, CH-1011, Lausanne, Switzerland., Breault S; Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland., Rigamonti F; Division of Cardiology, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland., Sotiriadis C; Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland., Jouannic AM; Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland., Qanadli SD; Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. salah.qanadli@chuv.ch.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2017 Jul; Vol. 27 (7), pp. 2843-2849. Date of Electronic Publication: 2016 Dec 12.
DOI: 10.1007/s00330-016-4666-y
Abstrakt: 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.
Databáze: MEDLINE
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