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Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates
Ali M Nadroo1, Ronald B Glass, Jing Lin
1Department of Pediatrics, Division of Newborn Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. anadroo@yahoo.com
Pediatrics
|July 3, 2002
Summary
Arm movements significantly impact peripherally inserted central catheter (PICC) tip position in neonates. Specific arm movements can be used to correct malpositioned PICCs, reducing risks associated with catheter migration.
Area of Science:
- Pediatric cardiology
- Medical device safety
- Vascular access
Background:
- Peripherally inserted central catheters (PICCs) are crucial for neonates but can migrate, risking serious complications like cardiac tamponade.
- Arm movements have been implicated in PICC displacement, potentially leading to dangerous malpositioning.
Purpose of the Study:
- To investigate how shoulder adduction/abduction and elbow flexion/extension affect PICC tip position in neonates.
- To determine if arm movements can be utilized to reposition malpositioned PICCs.
Main Methods:
- Review of 280 radiographs from 60 neonates with upper limb PICCs.
- Measurement of catheter tip displacement with paired radiographs during various arm movements.
- Attempted repositioning of malpositioned catheters using arm movements in 10 patients.
Main Results:
- Significant PICC tip displacement was observed with arm movements.
- Catheter migration varied based on the insertion vein (basilic/axillary vs. cephalic) and specific arm movements.
- Simultaneous shoulder adduction and elbow flexion caused the greatest catheter movement toward the heart.
Conclusions:
- Arm movements demonstrably influence PICC tip location in neonates.
- Understanding vein of insertion and monitoring tip position during maximal inward arm movement is key to preventing migration.
- Arm movements offer a viable method for correcting malpositioned PICCs.