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Liu B, Liu Y, Li J, Kang J, Sun W. A feasible and safe standardized protocol for ultrasound and intracavitary electrocardiogram-based tip navigation and tip location during placement of peripherally inserted central catheters. J Vasc Access 2024; 25:935-942. [PMID: 36527184 DOI: 10.1177/11297298221095039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are performed for medium and long term intravenous therapy. The most recent guidelines recommend the use of ultrasound-guided venipuncture to reduce surgery-related complications. In recent years, bedside ultrasound has also been used as evidence of accuracy in tip navigation and tip positioning. This paper is aimed to investigate using tip navigation with the ultrasonic technique and intracavitary electrocardiogram during the catheterization, and to suggest a feasible and safe standardized protocol for clinical practice. METHODS A total of 1727 tumor clients who suffered from combined the ultrasonic technique with intracavitary electrocardiogram (ECG + US group) to confirm the tip location of PICC were included in Peking Union Medical College Hospital in 2020. And based on electronic medical records according to the types of cancer as 1:1 to select 1727 cases who only underwent electrocardiogram (ECG group) to verify the tip location of catheters with the same team in 2019. Compared two groups of purpose of catheter, insertion site of upper limbs, times of puncture and delivery catheters, tip location and malposition of peripherally inserted central catheter, and analysis of the safety and feasibility. RESULTS There were no significant differences between the two groups in the purpose of catheter, insertion site of upper limbs, times of puncture, and delivery catheters. The percentage of optimal tip location in ECG + US group was significantly higher than that in ECG group, and the rate of malposition of catheters was obviously lower than that in ECG group (p < 0.001). CONCLUSIONS Tip navigation based with ultrasound and intracavitary electrocardiogram has high accuracy to confirm tip location of PICC, and it is also feasible and safe, which can not only to make up for the deficiency of patients without surface P waves who could not be applied ECG but also to fit for all patients.
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Affiliation(s)
- Bing Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Yan Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Jiaqian Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Junren Kang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Wenyan Sun
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
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Jang E, Son SM, Moon KY, Lee S, Han HS, Park SC, Kim JY, Yun SS. Analysis of tip malposition and correction of peripherally inserted central catheters under ultrasound-guidance: 5-year outcomes from a single center. J Vasc Access 2023:11297298231209564. [PMID: 38053249 DOI: 10.1177/11297298231209564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Peripherally inserted central catheter (PICC) has become a common procedure. Although ultrasound (US)-guidance has improved success rates, a small percentage of malposition is inevitable. The purpose of our study is to evaluate malposition rates of US-guided bedside PICC catheter insertion, and the clinical factors associated with malposition. METHODS This is a retrospective cohort study evaluating 5981 patients who had undergone ultrasound-guided bedside PICC placement from January 2017 to December 2021 at a single tertiary center. Final tip location was confirmed on chest radiograph. RESULTS Patients were categorized into optimal, suboptimal, and malposition groups according to final tip location. 4866 cases (81.7%) showed optimal tip position, 790 (13.3%) were suboptimal, and 299 (5.0%) were malpositioned. Logistic regression analysis identified six variables associated with tip malposition; height (odds ratio (OR) 1.044; 95% confidence interval (CI), 1.028-1.061; p < 0.001), body mass index (BMI) (OR 1.051; 95% CI, 1.017-1.087; p = 0.003), prior failure at accessing peripheral intravenous (IV) access (OR 1.718; 95% CI, 1.215-2.428; p = 0.002), side of the arm (OR 3.467; 95% CI, 2.457-4.891; p < 0.001), length of the catheter (OR 0.763; 95% CI, 0.734-0.794; p < 0.001), and number of previous central catheter insertions (OR 1.069; 95% CI, 1.004-1.140; p = 0.038). Malpositioned catheters were corrected by either bedside repositioning, bedside reinsertion, fluoroscopic reinsertion, switching to jugular catheters or catheter removal. No patient related factors were significantly associated with malposition or success of reposition. CONCLUSION US-guidance can help reduce catheter malposition during bedside PICC insertion. Patients with risk factors such as multiple previous central vein insertions, failed peripheral line insertions, left arm insertion, or high BMI should undergo thorough sonographic evaluation of the arm vessels to prevent malposition.
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Affiliation(s)
- Eunju Jang
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Soo Mi Son
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Ki-Yoon Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Seunghoon Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Hong Seok Han
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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Yeh TC, Chen CM, Cheng CH, Sheu CC, Tsai MJ, Chang WA. A modified method for measuring the length of peripherally inserted central catheters to reduce the risk of malposition during catheter insertion. SAGE Open Med 2023; 11:20503121231204488. [PMID: 37829287 PMCID: PMC10566264 DOI: 10.1177/20503121231204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
Background Malposition may occur during peripherally inserted central catheter insertion. Accurately measuring the length of a peripherally inserted central catheter is crucial to preventing malposition, including "long peripherally inserted central catheter placement," in which the tip of a peripherally inserted central catheter is deeper than the target position. The traditional method of measuring peripherally inserted central catheter length involves measuring from the insertion site to the parasternal notch and down to the third or fourth intercostal space, which may result in overestimation because of the thickness of the pectoralis major and anterior chest wall. To avoid this overestimation, the authors developed and tested a modified method for reducing long peripherally inserted central catheter placement. Methods This study employed a retrospective design. Chest X-rays were used to examine the peripherally inserted central catheter tip positions in 48 patients in the medical intensive care unit who had undergone peripherally inserted central catheter insertion. The traditional and modified measurement methods were used to measure the peripherally inserted central catheter length in 17 and 31 patients, respectively. Fisher's exact test was used to examine between-group differences in the incidence of different types of peripherally inserted central catheter malposition. Results The peripherally inserted central catheter tip position was near the target position in five patients (29.41%) in the traditional measurement group and 17 patients (54.84%) in the modified measurement group (p = 0.132), whereas long peripherally inserted central catheter placement occurred in six patients (35.29%) in the traditional measurement group and one patient (3.23%) in the modified measurement group (p = 0.006). However, the incidence of other types of peripherally inserted central catheter malposition did not differ significantly between the groups. Conclusions The results of this study that the proposed modified measurement method may be able to reduce the incidence of long peripherally inserted central catheter placement among medical intensive care unit patients. The method must be further evaluated in prospective studies and studies with larger sample sizes in the future.
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Affiliation(s)
- Tung-Chi Yeh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chia-Min Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chih-Hung Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Wei-An Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Johnson A, Cupp G, Armour N, Warren K, Stone C, Lee D, Gilbert N, Hammond C, Moore J, Kang YA. An Inexpensive Cardiovascular Flow Simulator for Cardiac Catheterization Procedure Using a Pulmonary Artery Catheter. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:764007. [PMID: 35047963 PMCID: PMC8757711 DOI: 10.3389/fmedt.2021.764007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiac catheterization associated with central vein cannulation can involve potential thrombotic and infectious complications due to multiple cannulation trials or improper placement. To minimize the risks, medical simulators are used for training. Simulators are also employed to test medical devices such as catheters before performing animal tests because they are more cost-effective and still reveal necessary improvements. However, commercial simulators are expensive, simplified for their purpose, and provide limited access sites. Inexpensive and anatomical cardiovascular simulators with central venous access for cannulation are sparse. Here, we developed an anatomically and physiologically accurate cardiovascular flow simulator to help train medical professionals and test medical devices. Our simulator includes an anatomical right atrium/ventricle, femoral and radial access sites, and considers the variability of arm position. It simulates physiological pulsatile blood flow with a setting for constant flow from 3 to 6 L/min and mimics physiological temperature (37°C). We demonstrated simulation by inserting a catheter into the system at radial/femoral access sites, passing it through the vasculature, and advancing it into the heart. We expect that our simulator can be used as an educational tool for cardiac catheterization as well as a testing tool that will allow for design iteration before moving to animal trials.
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Affiliation(s)
- Annika Johnson
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Grace Cupp
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Nicholas Armour
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Kyle Warren
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Christopher Stone
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Davin Lee
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | - Nicholas Gilbert
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
| | | | - John Moore
- TZ Medical Inc, Portland, OR, United States
| | - Youngbok Abraham Kang
- Department of Mechanical, Civil, and Biomedical Engineering, George Fox University, Newberg, OR, United States
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Hu Y, Ling Y, Ye Y, Zhang L, Xia X, Jiang Q, Sun F. Analysis of risk factors of PICC-related bloodstream infection in newborns: implications for nursing care. Eur J Med Res 2021; 26:80. [PMID: 34301331 PMCID: PMC8299687 DOI: 10.1186/s40001-021-00546-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background It is necessary to analyze the characteristics and risk factors of catheter-related bloodstream infection (CRBSI) in newborns with peripherally inserted central catheter (PICC). Methods Newborns undergoing PICC catheterization in the neonatal department of our hospital from January 1, 2020 to January 31, 2021 were included. The characteristics of newborns with and without CRBSI newborns were compared and analyzed. Logistic regression analyses were performed to evaluate the risk factors of CRBSI in newborns with PICC. Results Three hundred eighty-six newborns with PICC were included, of whom 41 newborns had the CRBSI, the incidence of CRBSI in newborns with PICC was 10.62%. There were significant differences regarding the birth weight, durations of PICC stay, 5-min Apgar score, site of PICC insertion of PICC between CRBSI and no CRBSI group (all P < 0.05), and there were no significant differences regarding the gender, gestational age, cesarean section, mechanical ventilation and length of hospital stay between CRBSI and no CRBSI group (all P > 0.05). Escherichia coli (26.08%) and Staphylococcus aureus (23.92%) were the most common CRBSI pathogens in newborns with PICC. Logistic regression analysis indicated that birth weight ≤ 1500 g (OR 1.923, 95% CI 1.135–2.629), durations of PICC stay ≥ 21 days (OR 2.077, 95% CI 1.024–3.431), 5-min Apgar score ≤ 7 (OR 2.198, 95% CI 1.135–3.414) and femoral vein insertion of PICC (OR 3.044, 95% CI 1.989–4.306) were the independent risk factors of CRBSI in neonates with PICC (all P < 0.05). Conclusion For newborns with low birth weight, longer durations of PICC stay and femoral vein PICC insertion, they may have higher risks of CRBSI, and medical staff should take targeted measures to reduce the development of CRBSI.
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Affiliation(s)
- Yan Hu
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China
| | - Yun Ling
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China.
| | - Yingying Ye
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China
| | - Lu Zhang
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China
| | - Xiaojing Xia
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China
| | - Qianwen Jiang
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China
| | - Fang Sun
- Department of Nursing, Children's Hospital, School of Medicine, Zhejiang University, No. 3333 Binsheng Road, Binjiang District, Hangzhou City, Zhejiang Province, China
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