title: Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs).
abstract: BACKGROUND
  PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move.
  
  
  OBJECTIVE
  To evaluate the influence of arm movement on the central tip location of PICCs placed in children.
  
  
  METHODS
  The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement.
  
  
  RESULTS
  The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90 degrees .
  
  
  CONCLUSIONS
  Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada. bairbre.connolly@sickkids.ca
authors.forename: Bairbre
authors.initials: B
authors.lastname: Connolly
authors.forename: Joao
authors.initials: J
authors.lastname: Amaral
authors.forename: Sharon
authors.initials: S
authors.lastname: Walsh
authors.forename: Michael
authors.initials: M
authors.lastname: Temple
authors.forename: Peter
authors.initials: P
authors.lastname: Chait
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
mesh_terms: D000293:Adolescent; D001132:Arm / Q000502:physiology*; D002405:Catheterization, Central Venous / Q000379:methods*; D002406:Catheterization, Peripheral; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009068:Movement; D011446:Prospective Studies; D016059:Range of Motion, Articular