Trerotola Scott O, Thompson Steven, Chittams Jesse, Vierregger Kristen S
Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce St, Philadelphia, PA 19104, USA.
J Vasc Interv Radiol. 2007 Apr;18(4):513-8. doi: 10.1016/j.jvir.2007.01.020.
To analyze the patterns of postplacement tip malposition in peripherally inserted central catheters (PICCs) placed at bedside, and to describe results of bedside and imaging-guided correction of tip malposition.
With use of a quality assurance database, all episodes of tip malposition in PICCs placed at bedside were reviewed. Catheter tip location, success or failure of bedside repositioning (in a subset of patients, by using over-the-wire techniques), findings in the interventional radiology (IR) division, and tip correction method used in the IR suite (repositioning vs replacement) were determined with a review of medical records.
During the 18-month study period, 2,367 attempts were made to place a PICC at bedside; 1,654 attempts (70%) were initially successful. Of these, 163 tips (10%) were malpositioned. Complete records for 132 malpositioned tips were available for analysis. Malpositioned tips were located in the ipsilateral internal jugular vein in 45 of the 132 cases (36%), axillary vein in 36 cases (27%), ipsilateral subclavian vein in 25 cases (19%), ipsilateral brachiocephalic vein in 15 cases (11%), contralateral subclavian vein in four cases (3%), contralateral brachiocephalic vein in two cases (2%), contralateral internal jugular vein in one case (1%), and subclavian tributary in one case (1%). In three cases (2%), the tip was coiled in the superior vena cava. Malposition was corrected with catheter exchange in 76 of the 132 cases (58%), repositioning in 48 cases (36%), or removal in one case (1%). Spontaneous correction occurred in seven of the 132 malpositioned tips (5%). One hundred nine tips (83%) were repositioned in the IR division with use of imaging guidance, with 100% success. Twenty-five attempts were made to correct malposition at bedside; 16 of those attempts (64%) were successful.
Tip malposition is relatively frequent with bedside placement of PICCs. Preliminary data suggest that most malpositions can be corrected with bedside techniques. Spontaneous correction may occur but is relatively uncommon.
分析床边放置的外周静脉穿刺中心静脉导管（PICC）置管后尖端位置异常的模式，并描述床边及影像引导下纠正尖端位置异常的结果。
利用质量保证数据库，回顾了所有床边放置PICC后出现尖端位置异常的情况。通过查阅病历确定导管尖端位置、床边重新定位的成功或失败（在一部分患者中，采用导丝技术）、介入放射科（IR）的检查结果以及在IR室采用的尖端纠正方法（重新定位与更换）。
在18个月的研究期间，共进行了2367次床边放置PICC的尝试；1654次尝试（70%）最初成功。其中，163个尖端（10%）位置异常。有132个位置异常的尖端的完整记录可供分析。132例中的45例（36%）位置异常的尖端位于同侧颈内静脉，36例（27%）位于腋静脉，25例（19%）位于同侧锁骨下静脉，15例（11%）位于同侧头臂静脉，4例（3%）位于对侧锁骨下静脉，2例（2%）位于对侧头臂静脉，1例（1%）位于对侧颈内静脉，1例（1%）位于锁骨下分支。3例（2%）中，尖端盘绕在上腔静脉内。132例中的76例（58%）通过更换导管纠正位置异常，48例（36%）通过重新定位纠正，1例（1%）拔除。132个位置异常的尖端中有7个（5%）自行纠正。109个尖端（83%）在IR科利用影像引导重新定位，成功率为100%。进行了25次床边纠正位置异常的尝试；其中16次尝试（64%）成功。
床边放置PICC时尖端位置异常相对常见。初步数据表明，大多数位置异常可通过床边技术纠正。可能会发生自行纠正，但相对少见。
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