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VOLUME 14 , ISSUE 4 ( October, 2010 ) > List of Articles

RESEARCH ARTICLE

Evaluation of length of central venous catheter inserted via cubital route in Indian patients

Saurabh Joshi, Anita Kulkarni, A.K. Bhargava

Keywords : Carina, central venous catheter, optimal length, peripherally inserted central venous catheter, radiopaque

Citation Information : Joshi S, Kulkarni A, Bhargava A. Evaluation of length of central venous catheter inserted via cubital route in Indian patients. Indian J Crit Care Med 2010; 14 (4):180-184.

DOI: 10.4103/0972-5229.76081

License: CC BY-ND 3.0

Published Online: 01-03-2018

Copyright Statement:  Copyright © 2010; The Author(s).


Abstract

Aim: Peripherally inserted central venous catheters (PICCs) are popular due to the ease of insertion, low cost and low risk of complications. Anteroposterior (AP) chest radiograph (CXR) is then obtained to assess the location of the catheter tip. But poor-quality X-rays remain a significant problem. We planned a study using radiopaque marker at sternal angle, as a radiological landmark, to relate height of the patient and optimal length of PICC fixation, at the antecubital fossa, and to know the incidence of malpositioning. Materials and Methods: A total of 200 patients aged above 20 years, scheduled for elective major cancer surgeries were studied. Vygoflex PUR, 16-G catheter, length 70 cm was used. The right or the left arm was chosen depending on the availability of veins. Catheter tip was observed in the post procedure CXR. Results: 200 patients [100 patients in group 1 (length of catheter fixation at antecubital fossa 45 cm) and 100 patients in group 2 (length of catheter fixation 50 cm)] were enrolled. The groups were further subdivided into 1a, 1b, 2a, 2b and results tabulated. Conclusions: Appropriate length of catheter fixation for group 1a was <45 cm, group 1b = 45 cm, group 2a = 50 cm, and for group 2b it was ≥50 cm. Gender and arm (right or left) did not have any bearing on the length of fixation. Incidence of malpositioning (15.5%) was more in right-sided catheters, more so, in short heighted people. PICC insertion via cubital route stands better compared with other routes, viz., Internal jugular vein IJV, subclavian and femoral.


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  1. Gupta B, Custer RM, Halim MY. An improved technique for antecubital central line placement. Anesth Analg 1994; 78:604.
  2. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. Br J Anaesth 2000; 85:192-4.
  3. Holt MH. Central venous pressure via peripheral veins. Anesthesiology 1967; 28:1093-5. Available from: http://www.journals.lww.com/anesthesiology/citation/1967/11000/central_venous_pressures_via_peripheral_veins.27.aspx [last accessed on 2010 Aug 28].
  4. Tocino IM, Watanabe A. Impending catheter perforation of superior vena cava: Radiographic recognition. AJR Am J Roentgenol 1986;146:487-90.
  5. Duntley P, Siever J, Korwes ML, Harpel K, Heffner JE. Vascular erosions by central venous catheters: Clinical features and outcome. Chest 1992;101:1633-8.
  6. Peres PW. Positioning central venous catheters: a prospective study. Anaesth Intensive Care 1990;18:536-9.
  7. Aldridge HE, Jay AW. Central venous catheters and heart perforation. CMAJ 1986;135:1082-6.
  8. Mukau L, Talamini MA, Sitzmann JV. Risk factors for central venous catheter related vascular erosions. JPEN J Parenter Enteral Nutr 1991;15:513-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1942462 [last accessed on 2010 Aug 28].
  9. Kalen V, Medige TA, Rinsky LA. Pericardial tamponade secondary to perforation by central venous catheters in orthopaedic patients. J Bone Joint Surg Am 1991;73:1503-6.
  10. McGee DC, Gould MK. Preventing Complications of Central Venous catheterization. N Engl J Med 2003;348:1123-33.
  11. Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: Where should the tip of the catheter lie. Br J Anaesth 2000;85:188-91.
  12. Orme RM, McSwiney MM, Chamberlain-Webber RF. Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: A case report and review of the literature. Br J Anaesth 2007;99:384-8.
  13. Caruso LJ, Gravenstein N, Layon AJ, Peters K, Gabrielli A. A better landmark for positioning a central venous catheter. J Clin Monit Comput 2002;17:331-4.
  14. Ezri T, Weisenberg M, Sessler DI, Berkenstadt H, Elias S, Szmuk P, et al. Correct depth of insertion of right internal jugular central venous catheters based on external landmarks: Avoiding the right atrium. J Cardiothorac Vasc Anesth 2007;21:497-501.
  15. Ryu HG, Bahk JH, Kim JT, Lee JH. Bedside prediction of the central venous catheter insertion depth. Br J Anaesth 2007;98:225-7.
  16. Czepizak CA, O′Callaghan JM, Venus B. Evaluation of formulas for optimal positioning of central venous catheters. Chest 1995;107:1662-4.
  17. Joshi AM, Bhosale GP, Parikh GP, Shah VR. Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula. Indian J Crit Care Med 2008;12:10-4.
  18. Gebhard RE, Szmuk P, Pivalizza EG, Melnikov V, Vogt C, Warters RD. The accuracy of electrocardiogram controlled central line placement. Anesth Analg 2007;104:65-70.
  19. Watters VA, Grant JP. Use of electrocardiogram to position right atrial catheters during surgery. Ann Surg 1997;225:165-71.
  20. Jeon Y, Ryu HG, Yoon SZ, Kim JH, Bahk JH. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anaesth 2006;53:978-83.
  21. Vesely TM. Central venous catheter tip position: A continuing controversy. J Vasc Interv Radiol 2003;14:527-34.
  22. Ragasa J, Shah N, Watson RC. Where antecubital catheters go: A study under fluoroscopic control. Anesthesiology 1989; 71:378-80.
  23. James L, Bledsoe L, Hadaway LC. A retrospective look at tip location and complications of peripherally inserted central lines. J Intraven Nurs 1993;16:104-9.
  24. Neuman ML, Murphy BD, Rosen MP. Bedside placement of peripherally inserted central catheters: a cost-effectiveness analysis. Radiology 1998;206:423-8.
  25. Deitel M, McIntyre JA. Radiographic confirmation of site of central venous pressure catheters. Can J Surg 1971;14:42-52.
  26. Johnston AO, Clark RG. Malpositioning of central venous catheters. Lancet 1972;2:1395-7.
  27. Bridges BB, Carden E, Takacs FA. Introduction of central venous pressure catheters through arm veins with a high success rate. Can Anaesth Soc J 1979;26:128-31.
  28. Kim KO, Jo JO, Kim HS, Kim CS. Positioning internal jugular venous catheters using the right third intercostal space in children. Acta Anaesthesiol Scand 2003;47:1284-6.
  29. Magder S. Invasive intravascular hemodynamic monitoring: Technical issues. Crit Care Clin 2007;23:401-14.
  30. Sayeed RA, Darling GE. Surface anatomy and surface landmarks for thoracic surgery. Thorac Surg Clin 2007;17:449-61.
  31. Evron S, Weisenberg M, Harow E, Khazin V, Szmuk P, Gavish D, et al. Proper insertion depth of endotracheal tubes in adults by topographic landmarks measurements. J Clin Anesth 2007;19:15-9.
  32. Dudek RW. High-yield lung. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 15.
  33. Ellis H, Feldman S, Harrop-griffiths W. Anatomy for anesthetists. 8th ed. NY: Blackwell; 2004. p. 49.
  34. Venkatesan T, Sen N, Korula PJ, Surendrababu NR, Raj JP, John P, et al. Blind placements of peripherally inserted antecubital central catheters: Initial catheter tip position in relation to carina. Br J Anaesth 2007;98:83-8.
  35. Burgess GE 3rd, Marino RJ, Peuler MJ. Effect of head position on the location of venous catheters inserted via basilica veins. Anesthesiology 1977;46:212-3.
  36. Fricke BL, Racadio JM, Duckworth T, Donnelly LF, Tamer RM, Johnson ND. Placement of peripherally inserted central catheters without fluoroscopy in children: Initial catheter tip position. Radiology 2005;234:887-92.
  37. Chaturvedi A, Bithal PK, Dash H, Chauhan RS, Mohanty B. Catheter malplacement during central venous cannulation through arm veins in pediatric patients. J Neurosurg Anesthesiol 2003;15:170-5.
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