PICC Placement in Humans Using Electromagnetic Detection
Author:
Douglas Buehrle, RN, Infusion Specialist, TVAP Inc. Durham NC.
A challenge is presented to the intravenous clinician in the placement of PICC Lines (Peripherally Inserted Central Catheters) positioning the catheter tip in a location just outside the heart in the lower 1/3 of the superior vena cava is the optimal position and tip termination point. The author reports the clinical evaluation of a new commercially available system that uses electromagnetic technology to sense the position of a catheter tip during PICC Line insertion. 300 catheters were placed using post insertion x-ray to confirm findings. The catheters were placed accurately in every case. It was noted that all 300 catheters placed were in the mid to lower third of the SVC (superior vena cava) The electromagnetic system provides the clinician placing PICC lines an opportunity to avoid malpositioning of catheters, which often occurs during insertion. (BIOMEDICAL INSTRUMENTATION & TECHNOLOGY, 1996;30:164-170)
Insertion of a PICC Line is a standard step prior to many applications and indications for the administration of intravenous solutions and medications. PICC lines are generally used for administration of antibiotics, chemotherapy, and TPN. The catheter is inserted via the anticubital region or upper basilic vein of the upper arm via ultrasound and provides an ideal low risk venous access for long-term therapy.
This technique is generally used for chemotherapy, or the administration of other irritating medications, as well as TPN (total parenteral nutrition). Correctly positioning the PICC tip in the superior vena cava (SVC) is important for optimal safety and function. Positioning of PICC lines is often performed using fluoroscopy, which is usually available only in a hospital operating room or within interventional Radiology dept.. Alternative insertion methods to confirm tip location is the use of X-RAY since most PICC lines are made of radiopaque material. As a consequence, catheter placement becomes an expensive procedure. PICC Lines could be placed in a variety of care settings; thus reducing billable medical expenses drastically. In addition to the high cost of fluoroscopy, its use exposes physicians, nursing staff, and patients to repeated doses of radiation. "Blind" placement procedures (without X-ray visualization) carry the inherent risk of catheter malpositioning, necessitating costly and troublesome repositioning procedures, multiple post procedure X-rays especially if the insertion was difficult. In light of these issues, the system described here, uses electromagnetic technology to guide PICC insertion.