Changes In Central Tip Location Of Peripherally Inserted Central Catheters(PICCs) When A Patient Is Upright Or Arm Movement

Objective: 1.To evaluate the influence of arm movements and postural changes on central tip location of peripherally inserted central catheter in adult and factors affecting catheter tip migration.2.Based on the result of our first part to discusses the effectiveness of withdraw 3 cm when know the catheter tip location at the CAJ.Methods: 1.A prospective trial was conducted from December 2015 to March 2016 in a Three-A hospital.70 patients requiring PICCs were inserted by Fluoroscopy-guided.The movement of the catheter were observed by the physician and the nurse.2.Another prospective trial was conducted from in April 2016 to October 2016 in the same hospital.180 patients requiring PICCs,which were randomized into control group(90 cases)and observation group(90 cases).Two kinds of index were monitored which include the effectiveness of ECG guiding PICC tip location,depth of the tip position in the SVC.Results: 1.There was a statistically significant(P<0.05)change in catheter position from the supine to upright and the arm from adduction to abduction.The mean difference of movement was(1.69±0.59)cm with abduction to adduction of the Upper extremity,(3.02±0.87)cm with the arm abduction 90°compared to erect.Side,patient sex,vein do not influence the range of movement significantly.2.There were no statistically significant differences among the two groups in items of the total accuracy of tip location,but the best place location were statistically significant differences among the two groups(P<0.05).The accuracy of the tip depth in SVC in control group is better than the observation group,but this did not attain significance(P =0.104).Conclusion: The catheter tip migrates significantly from the initial position at the time of placement as compared to when the patient assumes the erect position or the arm movement.This knowledge is important in achieving the desired final catheter position.Withdraw 3 cm when know the catheter tip location at the CAJ is much more better in the accuracy of the best place location when considering the relative changes of arm movement and patient position from supine to upright.