Immediate post-insertion tip migration of peripherally inserted central catheters dependent on arm position and depth of inspiration.

INTRODUCTION: The purpose of this study is to assess the degree of PICC tip migration with breathing and arm movement to determine whether accurate positioning is feasible or futile.

METHODS: A prospective cohort of 218 consecutive patients undergoing PICC insertion at our institution between January and August 2015 was selected, of which 129 met inclusion criteria. The position of insertion was used as control with the arm at 90° during inspiration, followed by three study images: expiration with arm unchanged, inspiration with arm fully adducted and inspiration with arm fully abducted. Mean and standard deviations (SD) of change in PICC position were determined. ANOVA, Pearson correlation coefficients and Chi-square tests were used to assess the effects of vessel choice, PICC calibre and angle of arm abduction. Complications were recorded.

RESULTS: Movement was predominantly caudal with a mean of 10.4 mm (SD 16.5) with similar degrees of movement in the expiration (12.3 mm) and adduction (12.9 mm) views (P = 0.709). Arm abduction resulted in a mean caudal movement of 6.5 mm. (SD 18.6); however, the degree of abduction had no predictable effect on PICC movement. Thirty-two per cent of cases demonstrated movement into the right atrium. Neither vessel choice nor type of PICC was shown to have a significant effect on PICC movement.

CONCLUSION: There is large amplitude of PICC tip position change with depth of inspiration and arm position resulting in frequent right atrial position. Despite this there were no associated complications in our cohort which compliments emerging international opinion regarding intra-atrial PICC tip position.