title: Blind placements of peripherally inserted antecubital central catheters: initial catheter tip position in relation to carina.
abstract: BACKGROUND
  We investigated how often blind placement of peripherally inserted central catheters (PICCs) through the antecubital veins results in a correct tip location in relation to carina and evaluated the inter-observer agreement in locating the tip of PICCs in plain radiography with digital imaging.
  
  
  METHODS
  In this study, 202 suitable chest radiographs with PICCs out of 803 patients were identified. An initial audit on the tip of these catheters in relation to carina was done by a consultant anaesthetist and was recorded as the first observer. The same sets of CXRs were examined by a consultant radiologist and the tips were identified and recorded as the second observer. Inter-observer agreement was assessed.
  
  
  RESULTS
  In 75 of 202 (37%), PICCs had a central tip location in relation to the carina. Fifty-five of 131 (42%) right-sided catheters had a central location compared with 20 of 71 (28%) of the left-sided catheters. The tip position for right-sided catheters was most frequently centrally located whereas the tip for left-sided catheters was most commonly positioned in the ipsilateral innominate vein. There was excellent agreement between the observers in reporting the tip of PICCs at all positions (kappa=0.87) including central locations (kappa=0.83).
  
  
  CONCLUSIONS
  Right antecubital PICCs are more likely to be placed in the central location in relation to the carina. PICCs inserted through the left antecubital veins need to be pushed further down to aim for a central location. Inter-observer variability in identifying the tip of PICCs is least with the introduction of digital imaging.
authors.affiliation: Department of Anaesthesia, Christian Medical College Hospital, Vellore, Tamil Nadu, India. tvenkatesan5@yahoo.co.in
authors.forename: T
authors.initials: T
authors.lastname: Venkatesan
authors.forename: N
authors.initials: N
authors.lastname: Sen
authors.forename: P J
authors.initials: PJ
authors.lastname: Korula
authors.forename: N R S
authors.initials: NR
authors.lastname: Surendrababu
authors.forename: J P
authors.initials: JP
authors.lastname: Raj
authors.forename: P
authors.initials: P
authors.lastname: John
authors.forename: S
authors.initials: S
authors.lastname: Christopher
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D015588:Observer Variation; D011859:Radiography; D011873:Radiology Information Systems; D012189:Retrospective Studies; D014132:Trachea / Q000000981:diagnostic imaging*