title: Peripherally inserted central catheter tip position: a novel empirical-ultrasonographical index in a modern surgical oncology department.
abstract: BACKGROUND
  The correct positioning of ultrasound-guided, peripherally inserted central catheters (UGPICCs) is essential to avoid multiple complications. We describe for the first time a retrospective study to evaluate a novel and easy transabdominal ultrasound-guided approach, so-called "Marano index," to place the UGPICCs tip correctly, making oncological surgeons able to obtain a high successful initial placement rate without postinsertion chest radiography.
  
  
  METHODS
  We examined the placement of UGPICCs applying, in 53 patients, the "Marano index." The tip catheter location was controlled by postprocedural chest radiography. Sensitivity, positive predictive value, and accuracy of index application also were calculated and compared with radiographic findings.
  
  
  RESULTS
  The ultrasonographic-guided insertion was successful in all patients (100%). The identification of catheter inside the inferior vena cava was registered in 50 patients (94.3%), and in all cases it was clear the precise catheter placement, after Marano index application, with the real tip position and the concordance between postprocedural radiography in 100% of cases. The overall accuracy of this novel empirical-ultrasonographical index was 94%, with positive predictive value of 94% and sensitivity of 100%.
  
  
  CONCLUSIONS
  This technique, once validated in a larger cohort, would allow the insertion of UGPICC without radiologic confirmation in selected patients with an adequate ultrasound body habitus. This would avoid unneeded radiation exposure from chest X-rays and would potentially save cost and time. This strategy provides only minimal deviation from the current practice and it is hence technically easy to learn and perform accurately with basic training by digestive oncological surgeons.
authors.affiliation: 8th Department of General and Gastrointestinal Surgery, School of Medicine - I Policlinico, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy, marano.luigi@email.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Marano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Izzo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.forename: Marianna
authors.initials: M
authors.lastname: Petrillo
authors.forename: Angelo
authors.initials: A
authors.lastname: Cosenza
authors.forename: Mario
authors.initials: M
authors.lastname: Marano
authors.forename: Alessio
authors.initials: A
authors.lastname: Fabozzi
authors.forename: Virginia
authors.initials: V
authors.lastname: Boccardi
authors.forename: Fernando
authors.initials: F
authors.lastname: De Vita
authors.forename: Natale
authors.initials: N
authors.lastname: Di Martino
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation*; D004067:Digestive System Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014463:Ultrasonography