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Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs)

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Abstract

Background

PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move.

Objective

To evaluate the influence of arm movement on the central tip location of PICCs placed in children.

Materials and methods

The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement.

Results

The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90°.

Conclusion

Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.

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References

  1. Chait PG, Ingram J, Phillips-Gordon C, et al (1995) Peripherally inserted central catheters in children. Radiology 197:775–778

    PubMed  CAS  Google Scholar 

  2. Miller KD, Deitrick CL (1997) Experience with PICC at a university medical center. J Intraven Nurs 20:141–147

    PubMed  CAS  Google Scholar 

  3. Crowley JJ, Pereira JK, Harris LS, et al (1997) Peripherally inserted central catheters: experience in 523 children. Radiology 204:617–621

    PubMed  CAS  Google Scholar 

  4. Schutz JC, Patel AA, Clark TW, et al (2004) Relationship between chest port catheter tip position and port malfunction after interventional radiologic placement. J Vasc Interv Radiol 15:581–587

    PubMed  Google Scholar 

  5. Connolly B, Mawson JB, MacDonald CE, et al (2000) Fluoroscopic landmark for SVC-RA junction for central venous catheter placement in children. Pediatr Radiol 30:692–695

    Article  PubMed  CAS  Google Scholar 

  6. Racadio JM, Doellman DA, Johnson ND, et al (2001) Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics 107:E28

    Article  PubMed  CAS  Google Scholar 

  7. Hogan MJ (1999) Neonatal vascular catheters and their complications. Radiol Clin North Am 37:1109–1125

    Article  PubMed  CAS  Google Scholar 

  8. Fricke BL, Racadio JM, Duckworth T, et al (2005) Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position. Radiology 234:887–892

    Article  PubMed  Google Scholar 

  9. Hacking MB, Brown J, Chisholm DG (2003) Position dependent ventricular tachycardia in two children with peripherally inserted central catheters (PICCs). Paediatr Anaesth 13:527–529

    Article  PubMed  Google Scholar 

  10. Forauer AR, Alonzo M (2000) Change in peripherally inserted central catheter tip position with abduction and adduction of the upper extremity. J Vasc Interv Radiol 11:1315–1318

    Article  PubMed  CAS  Google Scholar 

  11. Nadroo AM, Glass RB, Lin J, et al (2002) Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics 110:131–136

    Article  PubMed  Google Scholar 

  12. Male C, Julian JA, Massicotte P, et al (2005) Significant association with location of central venous line placement and risk of venous thrombosis in children. Thromb Haemost 94:516–521

    PubMed  CAS  Google Scholar 

  13. Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11:837–840

    Article  PubMed  CAS  Google Scholar 

  14. Menon G (2003) Neonatal long lines. Arch Dis Child Fetal Neonatal Ed 88:F260–262

    Article  PubMed  CAS  Google Scholar 

  15. Fletcher SJ, Bodenham AR (2000) Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth 85:188–191

    Article  PubMed  CAS  Google Scholar 

  16. Department of Health (2001) Review of four neonatal deaths due to cardiac tamponade associated with the presence of a central venous catheter. HMSO, London

    Google Scholar 

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Acknowledgement

We wish to thank Dr. Derek Armstrong for his assistance with the graphics.

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Authors and Affiliations

  1. Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    Bairbre Connolly, Joao Amaral, Sharon Walsh, Michael Temple & Peter Chait

  2. Population Health Sciences, The Hospital for Sick Children, University of Toronto, 125 Edward Street, Toronto, Ontario, M5G 1X8, Canada

    Derek Stephens

Authors
  1. Bairbre Connolly
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  2. Joao Amaral
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  3. Sharon Walsh
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  4. Michael Temple
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  5. Peter Chait
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  6. Derek Stephens
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Corresponding author

Correspondence to Bairbre Connolly.

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Connolly, B., Amaral, J., Walsh, S. et al. Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs). Pediatr Radiol 36, 845–850 (2006). https://doi.org/10.1007/s00247-006-0172-8

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  • DOI: https://doi.org/10.1007/s00247-006-0172-8

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