Early identification and management of secondary malposition of peripherally inserted central catheter

Objective To early identify and manage secondary malposition of peripherally inserted central catheter (PICC), and to reduce other PICC related complications. Methods A total of 8 509 patients were included form January 2017 to December 2018 in intravenous therapy department in the Second Affiliated Hospital of Medical College of Zhejiang University. PICC was implanted and the original tip location was in the superior vena cava (SVC). The function and complications of the catheter were evaluated during the indwelling process. X-ray was taken for every abnormal patient to confirm the route and tip position of the catheter. Tip malposition were adjusted by external manipulation (pulling out part of the catheter, changing body position, external percussion, rapid flushing with 0.9% sodium chloride) when patients’ situation were allowed. Results A total of 31 cases of PICC secondary malposition were early identified, 27 of them were treated with external manual reduction. Totally 19 cases succeeded, and 8 cases failed. The success rate was 70.4%. There was no other complication during the process. 3 cases were found venous thrombosis, and 1 case was unable to do external manipulation due to his poor situation. Conclusion X-ray is a simple and easy method to identify secondary malposition of PICC. Using external manipulation to adjust the tip position back to SVC is effective, and the complications are few, which is worthy of clinical application. Key words: Catheterization, peripheral; Secondary malposition; Identify; Manage