Evaluation techniques of the PICC tip placement

Abstract

Correct tip position of a peripherally inserted central venous catheter (PICC) is of paramount importance in order to ensure good catheter performances and to prevent severe complications such as venous thrombosis or vessel/heart perforation. PICCs are prone to high rates of primary malposition if placed without any intraoperative method of tip control, due to their pronounced flexibility and the long route they must go through to reach the atriocaval junction.Primary tip malposition not only exposes the patient to a wide range of infusion-related complications but also increases the average cost of the procedure, especially in high-volume centers, as it requires at least an over-guidewire replacement, in most cases a completely new venipuncture. An updated review of available techniques for controlling the position of the tip of the central catheter together with a proposal of a comprehensive algorithm to help choosing the best tip verification procedure is provided here.