Blind placements of peripherally inserted antecubital central catheters: initial catheter tip position in relation to carina

Background. We investigated how often blind placement of peripherallyinserted central catheters (PICCs) through the antecubital veinsresults in a correct tip location in relation to carina andevaluated the inter-observer agreement in locating the tip ofPICCs in plain radiography with digital imaging. Methods. In this study, 202 suitable chest radiographs withPICCs out of 803 patients were identified. An initial auditon the tip of these catheters in relation to carina was doneby a consultant anaesthetist and was recorded as the first observer.The same sets of CXRs were examined by a consultant radiologistand the tips were identified and recorded as the second observer.Inter-observer agreement was assessed. Results. In 75 of 202 (37%), PICCs had a central tip locationin relation to the carina. Fifty-five of 131 (42%) right-sidedcatheters had a central location compared with 20 of 71 (28%)of the left-sided catheters. The tip position for right-sidedcatheters was most frequently centrally located whereas thetip for left-sided catheters was most commonly positioned inthe ipsilateral innominate vein. There was excellent agreementbetween the observers in reporting the tip of PICCs at all positions(kappa=0.87) including central locations (kappa=0.83). Conclusions. Right antecubital PICCs are more likely to be placedin the central location in relation to the carina. PICCs insertedthrough the left antecubital veins need to be pushed furtherdown to aim for a central location. Inter-observer variabilityin identifying the tip of PICCs is least with the introductionof digital imaging.