title: Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement.
abstract: OBJECTIVE
  Peripherally inserted central catheter (PICC) use continues to increase, leading to the development of a blind bedside technique (BST) for placement. The aim of our study was to compare the BST with the fluoroscopically guided technique (FGT), with specific regard to catheter tip position (CTP).
  
  
  METHODS
  One hundred eighty patients were randomized to either the BST or the FGT. All procedures were done by the same interventional team and included postprocedural chest X-ray to assess CTP. Depending on the international guidelines for optimal CTP, patients were classified in three types: optimal, suboptimal not needing repositioning, and nonoptimal requiring additional repositioning procedures. Fisher's test was used for comparisons.
  
  
  RESULTS
  One hundred seventy-one PICCs were successful inserted. In the BST groups, 23.3% of placements were suboptimal and 30% nonoptimal, requiring repositioning. In the FGT group, 5.6% were suboptimal and 1.1% nonoptimal. Thus, suboptimal and nonoptimal CTP were significantly lower in the FGT group (p < 0.001).
  
  
  CONCLUSIONS
  Tip malposition rates are high when using blind BST, exposing the patient to an increased risk of deep venous thrombosis and catheter malfunction. Using the FGT or emerging technologies that could help tip positioning are recommended, especially for long-term indications.
  
  
  CONCLUSIONS
  • Bedside and fluoroscopy guided techniques are commonly used for PICC placement. • Catheter malposition is the major technical issue with the bedside technique. • Catheter malposition occurred in 53% of patients with the bedside technique.
authors.affiliation: Department of Angiology, University Hospital of Lausanne, Rue du Bugon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Glauser
authors.affiliation: Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Stephane
authors.initials: S
authors.lastname: Breault
authors.affiliation: Division of Cardiology, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rigamonti
authors.affiliation: Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Sotiriadis
authors.affiliation: Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Jouannic
authors.affiliation: Department of Radiology, Cardio-Thoracic and Vascular Unit, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. salah.qanadli@chuv.ch.
authors.forename: Salah D
authors.initials: SD
authors.lastname: Qanadli
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D062905:Central Venous Catheters / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology*
keywords: Blind bedside technique; Fluoroscopically guided technique; Intensive care unit; Peripherally inserted central catheters; Tip malposition