A modified method for measuring the length of peripherally inserted central catheters to reduce the risk of malposition during catheter insertion

Tung-Chi Yeh; Chia-Min Chen; Chih-Hung Cheng; Chau-Chyun Sheu; Ming-Ju Tsai; Wei-An Chang

doi:10.1177/20503121231204488

A modified method for measuring the length of peripherally inserted central catheters to reduce the risk of malposition during catheter insertion

SAGE Open Med. 2023 Oct 10:11:20503121231204488. doi: 10.1177/20503121231204488. eCollection 2023.

Authors

Tung-Chi Yeh¹, Chia-Min Chen¹, Chih-Hung Cheng¹, Chau-Chyun Sheu^{1

2}, Ming-Ju Tsai^{1

2}, Wei-An Chang^{1

2}

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.
² Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.

Abstract

Background: Malposition may occur during peripherally inserted central catheter insertion. Accurately measuring the length of a peripherally inserted central catheter is crucial to preventing malposition, including "long peripherally inserted central catheter placement," in which the tip of a peripherally inserted central catheter is deeper than the target position. The traditional method of measuring peripherally inserted central catheter length involves measuring from the insertion site to the parasternal notch and down to the third or fourth intercostal space, which may result in overestimation because of the thickness of the pectoralis major and anterior chest wall. To avoid this overestimation, the authors developed and tested a modified method for reducing long peripherally inserted central catheter placement.

Methods: This study employed a retrospective design. Chest X-rays were used to examine the peripherally inserted central catheter tip positions in 48 patients in the medical intensive care unit who had undergone peripherally inserted central catheter insertion. The traditional and modified measurement methods were used to measure the peripherally inserted central catheter length in 17 and 31 patients, respectively. Fisher's exact test was used to examine between-group differences in the incidence of different types of peripherally inserted central catheter malposition.

Results: The peripherally inserted central catheter tip position was near the target position in five patients (29.41%) in the traditional measurement group and 17 patients (54.84%) in the modified measurement group (p = 0.132), whereas long peripherally inserted central catheter placement occurred in six patients (35.29%) in the traditional measurement group and one patient (3.23%) in the modified measurement group (p = 0.006). However, the incidence of other types of peripherally inserted central catheter malposition did not differ significantly between the groups.

Conclusions: The results of this study that the proposed modified measurement method may be able to reduce the incidence of long peripherally inserted central catheter placement among medical intensive care unit patients. The method must be further evaluated in prospective studies and studies with larger sample sizes in the future.

Keywords: PICC placement; critical care; location; malposition; measurement; ultrasonography.