title: Analysis of tip malposition and correction in peripherally inserted central catheters placed at bedside by a dedicated nursing team.
abstract: OBJECTIVE
  To analyze the patterns of postplacement tip malposition in peripherally inserted central catheters (PICCs) placed at bedside, and to describe results of bedside and imaging-guided correction of tip malposition.
  
  
  METHODS
  With use of a quality assurance database, all episodes of tip malposition in PICCs placed at bedside were reviewed. Catheter tip location, success or failure of bedside repositioning (in a subset of patients, by using over-the-wire techniques), findings in the interventional radiology (IR) division, and tip correction method used in the IR suite (repositioning vs replacement) were determined with a review of medical records.
  
  
  RESULTS
  During the 18-month study period, 2,367 attempts were made to place a PICC at bedside; 1,654 attempts (70%) were initially successful. Of these, 163 tips (10%) were malpositioned. Complete records for 132 malpositioned tips were available for analysis. Malpositioned tips were located in the ipsilateral internal jugular vein in 45 of the 132 cases (36%), axillary vein in 36 cases (27%), ipsilateral subclavian vein in 25 cases (19%), ipsilateral brachiocephalic vein in 15 cases (11%), contralateral subclavian vein in four cases (3%), contralateral brachiocephalic vein in two cases (2%), contralateral internal jugular vein in one case (1%), and subclavian tributary in one case (1%). In three cases (2%), the tip was coiled in the superior vena cava. Malposition was corrected with catheter exchange in 76 of the 132 cases (58%), repositioning in 48 cases (36%), or removal in one case (1%). Spontaneous correction occurred in seven of the 132 malpositioned tips (5%). One hundred nine tips (83%) were repositioned in the IR division with use of imaging guidance, with 100% success. Twenty-five attempts were made to correct malposition at bedside; 16 of those attempts (64%) were successful.
  
  
  CONCLUSIONS
  Tip malposition is relatively frequent with bedside placement of PICCs. Preliminary data suggest that most malpositions can be corrected with bedside techniques. Spontaneous correction may occur but is relatively uncommon.
authors: Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce St, Philadelphia, PA 19104, USA. streroto@uphs.upenn.edu
authors: Scott O
authors: SO
authors: Trerotola
authors: Steven
authors: S
authors: Thompson
authors: Jesse
authors: J
authors: Chittams
authors: Kristen S
authors: KS
authors: Vierregger
mesh_terms: D002405:Catheterization, Central Venous / Q000451:nursing* / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000451:nursing* / Q000706:statistics & numerical data; D019992:Databases as Topic; D006801:Humans; D009746:Nursing, Team / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D012189:Retrospective Studies