Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

Abstract

Purpose:

To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients.

Methods:

A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement.

Results:

A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant (p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index (p = 0.009) and height (p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change.

Conclusion:

The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Keywords

Peripherally inserted central catheter chest X-ray tip location body posture change upright position supine position

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References

Bray

Ferlay

Soerjomataram

, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6): 394–424.

Chen

Zheng

Baade

, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016; 66(2): 115–132.

Pittiruti

La Greca

Scoppettuolo

The electrocardiographic method for positioning the tip of central venous catheters. J Vasc Access 2011; 12(4): 280–291.

Vesely

TM.

Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003; 14(5): 527–534.

INS. Infusion therapy standards of practice. J Infus Nurs 2016; 39(1S): S39–S55.

Orme

RML

McSwiney

Chamberlain-Webber

RFO.

Fatal cardiac tamponade as a result of a peripherally inserted central venous catheter: a case report and review of the literature. Br J Anaesth 2007; 99(3): 384–388.

McGee

Gould

MK.

Preventing complications of central venous catheterization. N Engl J Med 2003; 348: 1123–1133.

Taylor

Palagiri

AV.

Central venous catheterization. Crit Care Med 2007; 35: 1390–1396.

Nakazawa

Challenges in the accurate identification of the ideal catheter tip location. J Assoc Vasc Access 2010; 15(4): 196–201.

10.

Tan

Gibson

Central venous catheters: the role of radiology. Clin Radiol 2006; 61(1): 13–22.

11.

Rossetti

Pittiruti

Lamperti

, et al. The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study. J Vasc Access 2014; 16(2): 137–143.

12.

Wallace

Afonso

, et al. Factors that predict increased catheter tip movement in left internal jugular vein implantable venous access ports upon standing. J Vasc Access 2015; 16(3): 223–226.

13.

Kowalski

Kaufman

Rivitz

, et al. Migration of central venous catheters: implications for initial catheter tip positioning. J Vasc Interv Radiol 1997; 8(3): 443–447.

14.

Gibson

Bodenham

Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth 2013; 110(3): 333–346.

15.

Zheng

, et al. Influence of arm movement and postural changes on central tip location of peripherally inserted central catheter. Anhui Med Pharm J 2019; 23(1): 110–113.

16.

Xian

Yang

Xia

, et al. The effect of body posture change on the catheter tip position of totally implantable venous access port. J Interv Radiol 2018; 27(1): 20–23.

17.

Gapp

Krishnan

Ratnaraj

, et al. Cardiac arrhythmias resulting from a peripherally inserted central catheter: two cases and a review of the literature. Cureus 2017; 9(6): e1308.

18.

Alvarez

Schurmann

Smith

, et al. Position-dependent ventricular tachycardia related to peripherally inserted central venous catheter. Methodist Debakey Cardiovasc J 2016; 12(3): 177–178.

19.

Pittiruti

Lamperti

Late cardiac tamponade in adults secondary to tip position in the right atrium: an urban legend? A systematic review of the literature. J Cardiothorac Vasc Anesth 2015; 29(2): 491–495.