Acute and Critical Care

Original Articles

Surgery
Outcomes of bedside peripherally inserted central catheter placement: a retrospective study at a single institution: Sukyung Kwon, Soo mi Son, Seul Hee Lee, Joung Hee Kim, Hyangkyoung Kim, Jang Yong Kim, Ji Il Kim, In Sung Moon; Acute Crit Care. 2020;35(1):31-37. Published online February 11, 2020; DOI: https://doi.org/10.4266/acc.2019.00731

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Background
Bedside insertion of peripherally inserted central catheters (PICCs) has higher rates of malposition than fluoroscopic-guided PICC placement. This study evaluated the success rate of bedside PICC placement, variations in tip location, and risk factors for malposition. Methods: This retrospective study included patients who underwent bedside PICC placement from January 2013 to September 2014 in a single institution. The procedure was conducted under ultrasound guidance or by a blind method. After PICC placement, tip location was determined by chest X-ray. Results: The overall venous access success rate with bedside PICC placement was 98.1% (1,302/ 1,327). There was no significant difference in the venous access success rate between ultrasound-guided placement (868/880, 98.6%) and a blind approach placement (434/447, 97.1%). Optimal tip position was achieved on the first attempt in 1,192 cases (91.6%). Repositioning was attempted in 65 patients; 60 PICCs were repositioned at the bedside, two PICCs were repositioned under fluoroscopic guidance, and three PICCs moved to the desired position without intervention. Final optimal tip position after repositioning was achieved in 1,229 (94.4%). In logistic regression analysis, five factors associated with tip malposition included female sex (Exp(B), 1.687; 95% confidence interval [CI], 1.180 to 2.412; P=0.004), older age (Exp(B), 1.026; 95% CI, 1.012 to 1.039; P<0.001), cancer (Exp(B), 0.650; 95% CI, 0.455 to 0.929; P=0.018), lung disease (Exp(B), 2.416; 95% CI, 1.592 to 3.666; P<0.001), and previous catheter insertions (Exp(B), 1.262; 95% CI, 1.126 to 1.414; P<0.001). Conclusions: Bedside PICC placement without fluoroscopy is effective and safe in central venous catheters. Potential risk factors associated with catheter tip malposition include older age, female sex, cancer, pulmonary disease, and previous central vein catheterizations.

Citations

Citations to this article as recorded by

The Outcomes of Peripherally Inserted Central Catheter (PICC) Insertion in Pediatric Patients at Siriraj Hospital
Niracha Wongchompoo, Khanita Kasikan, Prasert Sawasdiwipachai
Siriraj Medical Journal.2024; 76(3): 135. CrossRef
Catheter detection by transthoracic echocardiography during placement of peripherally inserted central catheters: a real-time method for eliminating misplacement
Yong Chae Jung, Man-shik Shim, Hee Sun Park, Min-Woong Kang
Acute and Critical Care.2024; 39(2): 266. CrossRef
Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter
Midan Zhang, Xiaofei Chen, Hongqin Zhou, Meifang Xu
Innovative Journal of Pediatrics.2023;[Epub] CrossRef
Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter
Midan Zhang, Xiaofei Chen, Hongqin Zhou, Meifang Xu
Iranian Journal of Pediatrics.2023;[Epub] CrossRef
Feasibility of Ultrasound-Guided, Peripherally Inserted Central Catheter Placement at the Bedside in a Communicable-Disease Isolation Unit
Kyoung Won Yoon, Wongook Wi, Moon Suk Choi, Eunmi Gil, Chi-Min Park, Keesang Yoo
Journal of Personalized Medicine.2023; 13(5): 863. CrossRef
Development and validation of an updated PICC length prediction formula based on anteroposterior chest radiographs for the ultrasound-guided bedside placement
Hyoung Nam Lee, Sangjoon Lee, Sung-Joon Park, Youngjong Cho, Hwan Hoon Chung, Robert Jeenchen Chen
PLOS ONE.2023; 18(11): e0294598. CrossRef
Analysis of tip malposition and correction of peripherally inserted central catheters under ultrasound-guidance: 5-year outcomes from a single center
Eunju Jang, Soo Mi Son, Ki-yoon Moon, Seunghoon Lee, Hong Seok Han, Sun Cheol Park, Jang Yong Kim, Sang Seob Yun
The Journal of Vascular Access.2023;[Epub] CrossRef
Precision at the Bedside: Practical Efficacy of Clockwise Catheter Torque for Accurate Tip Positioning of Peripherally Inserted Central Catheters
Masayuki Akatsuka, Eriko Sugiyama
Cureus.2023;[Epub] CrossRef
Guidewire-Assisted Reduction Technology Combined with Postural Reduction Improves the Success Rate of Internal Vein Catheterisation
Feng-Xian Li, Yan-Ping Li, Hong-Yang Zhang, Mei-Jing Tian, Huan-Huan Gao, Gui-Juan Zhang, Peng Su, Daniel Espino
Journal of Healthcare Engineering.2022; 2022: 1. CrossRef
Therapeutic Effect of Ultrasound-Guided Peripherally Inserted Central Catheter Combined with Predictive Nursing in Patients with Large-Area Severe Burns
Baiyan He, Aiqiong Zhang, Shuting He, Pan Zheng
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Bedside peripherally inserted central catheter placement: focus on the procedure
Dong Hun Kim
Trauma Image and Procedure.2022; 7(1): 21. CrossRef
Validation of the PICC length prediction formula based on anteroposterior chest radiographs for bedside ultrasound-guided placement
Youngjong Cho, Sangjoon Lee, Sung-Joon Park, Hyoung Nam Lee, Hwan Hoon Chung, Robert Jeenchen Chen
PLOS ONE.2022; 17(11): e0277526. CrossRef
Feasibility of Peripherally Inserted Central Catheter Placement in COVID-19 Patients Isolated in the Intensive Care Unit of a Small Volume Center (291-Bed Hospital)
Min Chang Kang, Kyungwon Lee
Journal of Acute Care Surgery.2022; 12(3): 125. CrossRef
Prevalence of complications associated with the use of a peripherally inserted central catheter in newborns: A systematic review protocol
Edienne Rosângela Sarmento Diniz, Kleyton Santos de Medeiros, Richardson Augusto Rosendo da Silva, Ricardo Ney Cobucci, Angelo Giuseppe Roncalli, Raffaele Serra
PLOS ONE.2021; 16(7): e0255090. CrossRef
Ultrasound-guided insertion of peripherally inserted central catheter after anesthetic induction in children undergoing surgery for moyamoya disease - Thirty cases report-
Sang-Hwan Ji, Sol Ji Yoo, Sung-Ae Cho, Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim
Anesthesia and Pain Medicine.2021; 16(3): 273. CrossRef
Comparing the accuracy and complications of peripherally inserted central catheter (PICC) placement using fluoroscopic and the blind pushing technique
Brendan Erskine, Pierre Bradley, Tim Joseph, Sabrina Yeh, Warren Clements
Journal of Medical Radiation Sciences.2021; 68(4): 349. CrossRef
Pneumothorax as a rare complication of peripherally inserted central catheter (PICC) in neonates: A case report study
Rasoul Goli, Sina Zafarmokhtarian, Mahmoodreza Ghalandari, Navid Babakeshi-sheytanabad, Sajjad Rostami, Hossna Farajollahi
International Journal of Surgery Case Reports.2021; 88: 106472. CrossRef

Vascular Surgery
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter: Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho; Korean J Crit Care Med. 2015;30(4):280-285. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.280

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Abstract PDF

Background
We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. Methods: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. Results: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). Conclusions: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.

Citations

Citations to this article as recorded by

Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report
Parag Gharde, Sourangshu Sarkar, Kalpana Irpachi, Amol Kumar Bhoje, Bhavdeep Kaur, Sandeep Chauhan
A&A Practice.2020; 14(10): e01291. CrossRef

Case Report

Thoracic Surgery
A Rare Case of Massive Hemothorax due to Central Venous Catheterization Treated with Angiographic Stent Implantation: Jung-Min Bae; Korean J Crit Care Med. 2015;30(1):18-21. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.18

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Abstract PDF: In critically ill patients, centeral venous catheterization is a widely used procedure for fluid resuscitation, massive transfusion, total parenteral nutrition, central venous pressure monitoring and hemodialysis. However, many complications are associated with central venous catheterization. Among these complications, hemothorax is rare but fatal. We recently experienced a 32-year-old female diagnosed with hemothorax due to subclavian catheterization who was successfully treated with angiographic intervention. There are no absolute indications of surgery or interventional treatment in such cases. Multicenter studies and consensus are necessary to determine the proper treatment for hemothorax due to central venous catheterization. Angiographic treatment is rarely used for this uncommon complication of subclavian catheterization. We describe a rare case with a review of the literature.

Original Article

Emergency
Interruption of Chest Compression for Central Venous Catheterization during Cardiopulmonary Resuscitation: Yong Oh Kim, Hyun Soo Park; Korean J Crit Care Med. 2014;29(3):172-176. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.172

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86 Download
2 Crossref

Abstract PDF

BACKGROUND
Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR.
METHODS
This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR.
RESULTS
During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC.
CONCLUSIONS
During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.

Citations

Citations to this article as recorded by

Comparison between internal jugular vein access using midline catheter and peripheral intravenous access during cardiopulmonary resuscitation in adults
Hyun Seok Chai, Young-Min Kim, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Ji Han Lee
SAGE Open Medicine.2023; 11: 205031212311753. CrossRef
Femoral venous oxygen saturation obtained during CPR predicts successful resuscitation in a pig model
Mu Jin Kim, Kyung Woon Jeung, Byung Kook Lee, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Yong Il Min
The American Journal of Emergency Medicine.2015; 33(7): 941. CrossRef

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