Central venous line placement is not compromised by the choice between different insertion sites. Study performed in cardiovascular surgery patients

INTRODUCTION: Peripherally inserted central catheters, or PICC lines, are frequently used for central venous access because they reduce complications associated with large vein cannulation (CVC). Adequate position of the tip of the catheter is important to central venous pressure (CVP) measurement and drug administration. Inadequate positioning and procedural complications mandate radiologic confirmation. Divergent results have been published comparing techniques. METHODOLOGY: The authors analyzed the placement of 117 central venous lines and compared the position of the tip of the catheter by chest x-ray using SPSS_20.0(®). RESULTS: Fifty-eight (49,6%) PICC inserted via right arm veins, 29(24.8%) PICC via left arm veins and 30(25.6%) internal jugular CVC were recorded. The tip was misplaced in 33(28.2%). Choice between PICC or CVC did not affect the position (p=0.22). Neither the vein [basilic, cephalic, median cubital or jugular] (p>0.4) nor the side [right or left arm] chosen compromised adequate positioning, although distal vein catheters are less likely be easily advanced. CVP measurements were accurate in >80% of the catheters and were no different in CVC or PICC (p>0.5). The catheter patency was a good indicator for adequate positioning. CONCLUSION: CVC or PICC are equally effective for central venous access and CVP measurements. No difference was found between left or right arm PICC. One third of the catheters had the tip misplaced, which reinforces the need for radiologic confirmation.