Joshi Saurabh, Kulkarni Anita, Bhargava A K
Department of Anesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India.
Indian J Crit Care Med. 2010 Oct;14(4):180-4. doi: 10.4103/0972-5229.76081.
Peripherally inserted central venous catheters (PICCs) are popular due to the ease of insertion, low cost and low risk of complications. Anteroposterior (AP) chest radiograph (CXR) is then obtained to assess the location of the catheter tip. But poor-quality X-rays remain a significant problem. We planned a study using radiopaque marker at sternal angle, as a radiological landmark, to relate height of the patient and optimal length of PICC fixation, at the antecubital fossa, and to know the incidence of malpositioning.
A total of 200 patients aged above 20 years, scheduled for elective major cancer surgeries were studied. Vygoflex PUR, 16-G catheter, length 70 cm was used. The right or the left arm was chosen depending on the availability of veins. Catheter tip was observed in the post procedure CXR.
200 patients [100 patients in group 1 (length of catheter fixation at antecubital fossa 45 cm) and 100 patients in group 2 (length of catheter fixation 50 cm)] were enrolled. The groups were further subdivided into 1a, 1b, 2a, 2b and results tabulated.
Appropriate length of catheter fixation for group 1a was <45 cm, group 1b = 45 cm, group 2a = 50 cm, and for group 2b it was ≥50 cm. Gender and arm (right or left) did not have any bearing on the length of fixation. Incidence of malpositioning (15.5%) was more in right-sided catheters, more so, in short heighted people. PICC insertion via cubital route stands better compared with other routes, viz., Internal jugular vein IJV, subclavian and femoral.
经外周静脉穿刺中心静脉导管（PICC）因插入操作简便、成本低且并发症风险低而广受欢迎。随后需拍摄胸部前后位（AP）X线片以评估导管尖端的位置。但X线片质量不佳仍是一个重大问题。我们计划开展一项研究，使用胸骨角处的不透射线标记物作为放射学标志，将患者身高与在肘前窝处PICC固定的最佳长度相关联，并了解导管位置不当的发生率。
共研究了200例年龄在20岁以上、计划接受择期重大癌症手术的患者。使用Vygoflex PUR 16-G导管，长度为70 cm。根据静脉情况选择右臂或左臂。在术后X线片上观察导管尖端位置。
纳入200例患者[第1组100例（导管在肘前窝处固定长度为45 cm），第2组100例（导管固定长度为50 cm）]。这些组进一步细分为1a、1b、2a、2b组，并将结果制成表格。
第1a组导管固定的合适长度<45 cm，第1b组=45 cm，第2a组=50 cm，第2b组≥50 cm。性别和手臂（右侧或左侧）对固定长度没有任何影响。右侧导管位置不当的发生率（15.5%）更高，在身材矮小的人群中更是如此。与其他途径（即颈内静脉、锁骨下静脉和股静脉）相比，经肘途径插入PICC的效果更好。
