Placement of the tip of a peripherally inserted central catheter in the lower third of the superior vena cava is essential to minimize the risk of complications. Sometimes, however, the catheter tip cannot be localized clearly on the chest radiograph, and repositioning a catheter at bedside is difficult, sometimes impossible. A chest radiograph obtained just after the catheter is inserted, before the guidewire is removed, can be helpful. With the guidewire in the catheter, the catheter and its tip can be seen clearly on the radiograph. If the catheter was inserted via the wrong route or the tip is not at the appropriate location, the catheter can be repositioned easily with the guidewire in it. Between January 1, 2007, and May 31, 2009, 225 catheters were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned. The tips of all these catheters were repositioned in the lower third of the superior vena cava by using this method. No catheter was exchanged or removed. The infection rate for catheter placement did not increase when this method was used. This modification facilitates accurate location of the catheter tip on the chest radiograph, making it easy to correct any malposition (by withdrawing, advancing, or even reinserting the catheter after withdrawal).
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1 April 2011
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April 01 2011
Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier
Geng Tian, MD;
Geng Tian is a physician and Yan Zhu is a nurse in the tumor department and Bin Chen is a physician and Li Qi is a nurse in the nursing department at Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
Corresponding author: Geng Tian, md, Department of Tumor, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University in Shenzhen, 3002 Sungang West Road, Shenzhen 518035, China (e-mail: [email protected]).
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Bin Chen, MD;
Bin Chen, MD
Geng Tian is a physician and Yan Zhu is a nurse in the tumor department and Bin Chen is a physician and Li Qi is a nurse in the nursing department at Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Li Qi, RN, BSN;
Li Qi, RN, BSN
Geng Tian is a physician and Yan Zhu is a nurse in the tumor department and Bin Chen is a physician and Li Qi is a nurse in the nursing department at Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Yan Zhu, RN, BSN
Yan Zhu, RN, BSN
Geng Tian is a physician and Yan Zhu is a nurse in the tumor department and Bin Chen is a physician and Li Qi is a nurse in the nursing department at Shenzhen Second People’s Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Crit Care Nurse (2011) 31 (2): 64–69.
Citation
Geng Tian, Bin Chen, Li Qi, Yan Zhu; Modified Insertion of a Peripherally Inserted Central Catheter: Taking the Chest Radiograph Earlier. Crit Care Nurse 1 April 2011; 31 (2): 64–69. doi: https://doi.org/10.4037/ccn2011966
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