Acute Crit Care.  2024 May;39(2):266-274. 10.4266/acc.2024.00150.

Catheter detection by transthoracic echocardiography during placement of peripherally inserted central catheters: a real-time method for eliminating misplacement

• Jung YC
• Shim Ms
• Park HS
• Kang MW

• KMID: 2557243
• DOI: http://doi.org/10.4266/acc.2024.00150

Abstract

Background
Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement. Methods: This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications. Results: Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%–99.36%), 90% CI (55.50%–99.75%), 99%, and 75%, respectively. Conclusions: TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.

Keyword

catheterization; echocardiography; peripherally inserted central catheter

Figure

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  Figure 1. Before sterile draping: (A) rapid assessment of the peripheral vein by linear probe (12L) and (B) the best point for echocardiography in the apical four-chamber or subcostal view clearly shows the right atrial cavity by the echocardiographic probe (3Sc-RS) (GE Vivid S5 Ultrasound System).

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  Figure 2. Transthoracic echocardiography during peripherally inserted central catheter, apical four-chamber view: (A) hyperechogenic line (arrowhead represents the catheter heading from the RA to the RV) and (B) hyperechogenic artifact (arrow represents the catheter tip at the RV). LV: left ventricle; RV: right ventricle; RA: right atrium; LA: left atrium.

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  Figure 3. Study protocol used to analyze the diagnostic test. PICC: peripherally inserted central catheter; TTE: transthoracic echocardiography; RaPeVa: rapid peripheral vein assessment; Rt: right; Lt: left; CXR: chest x-ray; SVC–RA: superior vena cava–right atrium.

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