The use of confirming x-rays to verify tip position for peripherally inserted catheters.

The tips of long-line peripherally inserted catheters may be positioned in the superior vena cava (SVC), subclavian vein, or axillary vein. Based on current standards of practice, catheters with tips placed in the SVC are central lines that require a confirming x-ray; catheters with tips terminating in the subclavian or axillary vein are noncentral and do not require confirming x-rays. Several authors follow this standard; others, however, suggest that radiographic examination should be performed on catheters with tips lying in locations other than SVC unless numerous specific criteria are met. In this study, x-rays were obtained for 42 patients in a hospital setting to determine tip location and position. Radiographic examination revealed that six were looped and five were positioned in a branch or tributary off the axillary vein. To eliminate the complications associated with catheter tip malposition (i.e., thrombus, occlusion), x-ray confirmation should be performed on all lines placed in or beyond the axillary vein to ensure correct tip position.