The Clinical Study On Tip Orientation Under Ultrasonic Monitoring During Peripherally Inserted Central Catheter Operation

Objective: To analysis the accuracy of the length of PICC placement by ultrasonicmonitoring method of measurement and discuss its clinical value in PICC catheter.Methods: A total of174cases were recruited and assigned to the intervention and controlgroups respectively. Among them,89cases in the intervention received the insertionguided by ultrasound that identified the tip position and the depth of the catheter duringPICC. The other85cases of the control group used the method of body surfacemeasurement during PICC. The successful insertion shown by X-ray, would be with the tipof the catheter located in the lower section of superior vena cava. If the catheter tip enteredthe right atrium, the insertion would be regarded as too deep. The insertion would be tooshallow if the catheter tip in the upper section of the superior vena cava. If the catheter tipdid not enter the Superior vena cava, the insertion would be regarded as a failure.Results: In the intervention group,2cases had an insertion that was too deep,1case thatwas too shallow and1case with movement to the contralateral arm vein; giving a successrate of92.1%. In the control group, there were8cases with the movement to the internaljugular vein,1case to the ipsilateral axillary vein, and10cases too deep; giving a successrate of77.6%.(X2=7.18，P=0.007). In the intervention group, there were85cases with theinsertion to the superior vena cava,2cases where the insertion was too deep and1casewhere the insertion was too shallow; giving a success rate of96.5%. In the control group,there were76cases with the insertion to the superior vena cava,10cases where theinsertion was too deep; giving a success rate of86.8%.(X2=5.012，P=0.025). There was1case of movement in the86cases in the intervention group (excluding3cases where thelocation could not be identified), the incidence of movement1.16%. There were9cases ofmovement in the85cases of the control group, with the incidence rate of movement 10.59%.(X2=5.292，P=0.021). Regarding the successful rate of the intervention group,there was no significant statistical difference on the insertion depth between the two sides.Conclusion:1. The method using ultrasonic monitoring when retracting the guide wire to identify thetip of PICC had a similar successful rate as an X-ray. It not only allowed the timelydetection and adjustment of the guide wire movement, but also made it feasible to measurethe length of the catheter in the brachiocephalic vein and superior vena cava.2. It was better than the traditional body surface measurement in terms of the success rateand the accuracy of the actual length measurement. Compared with other identificationmethods, this method was quicker, more accurate, less painful, simple and repeatable andis suggested as the most suitable method to be used to identify the catheter depth duringPICC for most adults.3. Some patients required a combination of body X-ray measurement and the body surfacemeasurement.