Can Peripheral Gentral Venous Lines be inserted safely and successf ully where X-ray facilities are no available?

Abstract

Background: Primary care settings often lack facilities for radiological evaluation of the position of supra-and infra-clavicularly inserted central Yenous catheters' lf peripherally inserted central venous lines could reliably be successfully inserted this would make the need for immediate confirmatory radiological studies less crucial. Previous studies with peripherally inserted catheters reported a low success rate.This study was performed to determine whether the placement of a more flexible peripherally inserted catheter, the Arrow PICC (Arrow PS-O165 l), would result in an improved and acceptable success rate. Method: Twenty-three patients in the casualty unit of the Mamelodi Hospital during 1997 and 1998, who required a central venous line and had this inserted via the peripheral venous route were evaluated after insertion of the catheter. The best basilic or median cubital vein in the cubital fossa was used for insertion following a standardized method.A number of l4 catheters were inserted in the right arm and 9 were inserted in the left arm. The position of the placement was assessed by an AP supine chest X-ray. Results: Successful placement was achieved in 9l% of insertions (21 of 23 catheters). In both of the unsuccessful placements the catheter tip was located in the ipsilateral internal jugular vein. (One on the left and one on the right') No clinically significant complications resulted from these procedures. Conclusions: This study showed that central venous catheterisation with soft catheters (ArrowPlCC- Arrow PS-O1651), via visible palpable peripheral veins in the cubital fossa is easy to perform and is a safe procedure with a high success rate for correct catheter placement. This route warrants serious consideration when central venous catheterisation is desirable, especially in settings where X-ray facilities are not available to exclude complications or confirm placement.