Document Detail

Are supine chest and abdominal radiographs the best way to confirm PICC placement in neonates?
MedLine Citation:
PMID:  20085874     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Peripherally inserted central catheters (PICCs) are commonly used in NICUs. Although they have many benefits, they also have many potential complications. Confirming catheter tip position is essential to decreasing complications, but the best method to achieve confirmation is unclear. OBJECTIVES: Literature review for studies that address line position confirmation to assist health care providers in evaluating the available research and to identify gaps in the literature. METHOD: A literature search of four major databases followed by an ancestry approach was performed. Articles reviewed specifically discuss PICC lines and PICC line placement confirmation. RESULTS: Data on confirming PICC placement were lacking. Fluoroscopic placement is ideal, but cannot be done at the bedside and is costly. Supine chest radiograph is the most widely used method and is convenient, but when line tip position is unclear, contrast or ultrasound confirmation can be used. When PICC lines are placed in the saphenous vein, infants may benefit from supine and lateral abdominal radiographs to ensure placement in the inferior vena cava. DISCUSSION: More studies are needed to generalize findings. PICC line tips should be located in the superior vena cava or inferior vena cava close to the junction with the right atrium (0.5-1 cm outside of the cardiac chambers in premature infants and 1-2 cm outside of the cardiac chambers in larger infants). Arm position is very important when performing radiographs for placement because movement of the arm can cause migration of the catheter. There is also significant inter-observer variability when identifying line tip position.
Nicole Sneath
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Review    
Journal Detail:
Title:  Neonatal network : NN     Volume:  29     ISSN:  1539-2880     ISO Abbreviation:  Neonatal Netw     Publication Date:    2010 Jan-Feb
Date Detail:
Created Date:  2010-01-20     Completed Date:  2010-04-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8503921     Medline TA:  Neonatal Netw     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-35     Citation Subset:  N    
Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba.
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MeSH Terms
Catheterization, Central Venous / methods*
Catheters, Indwelling
Contrast Media / diagnostic use
Infant, Newborn
Intensive Care, Neonatal / methods*
Observer Variation
Radiography, Abdominal*
Radiography, Thoracic*
Reproducibility of Results
Signal Processing, Computer-Assisted
Supine Position
Ultrasonography, Interventional
Reg. No./Substance:
0/Contrast Media

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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