Change in peripherally inserted central catheter tip position with abduction and adduction of the upper extremity

This study examines whether the tip of peripherally inserted central catheters (PICCs) moves significantly with changes in arm position from abduction to adduction.

The catheters were inserted in the brachial or basilic veins under ultrasonographic guidance with the upper extremity in a 90 degrees abducted position. A flexible, radiopaque ruler was then placed on the anterior chest and digital images were obtained with the arm abducted and adducted in a similar phase of quiet respiration. Catheter tip movement was measured with use of the radiopaque ruler and fixed, bony anatomic landmarks.

Sixty-one consecutive PICCs were placed and evaluated during the study period (eight patients were excluded). Thirty-three catheters were placed from the right arm and 20 from the left. Overall, 43 moved caudally, seven moved cephalad, and three did not move with movement of the arm from abduction to adduction. Of those that moved caudal, the mean distance of movement was 21 mm (range, 2-53 mm). Right arm PICCs tended to move more than left arm PICCs, but this did not attain significance (P = .29).

There is a tendency for the PICC tip to move in a caudal direction with the change in arm position from abduction to adduction; 58% of PICCs moved 20 mm or more. This change in position should be considered during final catheter tip positioning.