Elli Stefano, Bellani Giacomo, Cannizzo Luigi, Giannini Luciano, De Felippis Christian, Vimercati Simona, Madotto Fabiana, Lucchini Alberto
Emergency Department and Intensive Care, University of Milano-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza, MB, Italy.
University of Milano-Bicocca, Milano, Italy.
J Vasc Access. 2020 Nov;21(6):917-922. doi: 10.1177/1129729820911225. Epub 2020 Mar 31.
Peripherally inserted central catheters are very common devices for short, medium and long-term therapies. Their performance is strictly dependent on the correct tip location, at the junction between the upper caval vein and the right atrium. It is very important to obtain an estimated measure of the catheter, in order to reach the cavo-atrial junction and optimize the catheter length. Estimated measures are often obtained using cutaneous landmarks.
Evaluate the reliability of cutaneous landmark-based length estimation during catheter insertion. Identify any patient's related factors that may affect cutaneous landmarks reliability.
We used two distinct techniques and collected data about cutaneous landmark-based length estimation, electrocardiographic guided intravascular length, age, weight and height. We studied the reliability of possible correcting factors, balancing the error average by regression models, and we found and tested two different models of prediction.
A total number of 519 patients were studied. The average bias, between the two studied length assessment by cutaneous landmarks and electrocardiographic guided catheter length, were 3.77 ± 2.44 cm and 3.28 ± 2.57 cm, respectively. The analysed prediction models (deviance explained 43.5%, Akaike information criterion = 1313.67% and 43.4%, Akaike information criterion = 1313.92), fitted on the validation set, showed a root mean square error of 3.07 and 3.06.
Landmark-based length estimation for preventive catheter length assessment seems to be unreliable, when associated with post-procedural tip location. They are useful for distal trimming catheters to optimize the 'out of skin' portion when associated with electrocardiographic tip location. Models identified for balancing bias are probably not useful.
外周静脉穿刺中心静脉导管是用于短期、中期和长期治疗的非常常见的装置。其性能严格取决于正确的尖端位置，即上腔静脉与右心房的交界处。为了到达腔房交界处并优化导管长度，获得导管的估计长度非常重要。估计长度通常使用体表标志来获得。
评估导管插入过程中基于体表标志的长度估计的可靠性。识别可能影响体表标志可靠性的任何患者相关因素。
我们使用了两种不同的技术，并收集了关于基于体表标志的长度估计、心电图引导下的血管内长度、年龄、体重和身高的数据。我们研究了可能的校正因素的可靠性，通过回归模型平衡平均误差，并发现并测试了两种不同的预测模型。
共研究了519例患者。通过体表标志和心电图引导的导管长度进行的两种研究长度评估之间的平均偏差分别为3.77±2.44厘米和3.28±2.57厘米。在验证集上拟合的分析预测模型（偏差解释率为43.5%，赤池信息准则=1313.67%和43.4%，赤池信息准则=1313.92）的均方根误差为3.07和3.06。
与术后尖端位置相关时，基于体表标志的预防性导管长度估计似乎不可靠。当与心电图尖端位置相关时，它们有助于修剪导管远端以优化“皮肤外”部分。为平衡偏差而确定的模型可能无用。
