Repositioning techniques of malpositioned peripherally inserted central catheters

To describe potential repositioning techniques of malpositioned peripherally inserted central catheters.

Various repositioning methods have been applied in clinical practice in managing malpositioned peripherally inserted central catheters, and many of them are proved effective. However, little publication reviewed on those literatures describing repositioning techniques to malpositioned peripherally inserted central catheters.

Systematic review. The repositioning techniques were classified and concretely described according to different locations of malpositioned peripherally inserted central catheter tips.

Literature and relevant guidelines were reviewed, focusing on malpositioned locations and incidence, as well as repositioning skills to peripherally inserted central venous catheters. Six databases were searched, including MEDLINE, web of science, CINAHL, Cochrane library, Wanfang database and Chinese National Knowledge Infrastructure. The articles (n = 21) were analysed using inductive content analysis.

The malpositioned locations of postplacement peripherally inserted central catheter tips mainly include right atrium, right ventricular, axillary vein, ipsilateral and contralateral internal jugular vein, subclavian vein, brachiocephalic vein, other small venous branches or catheter looped. Repositioning techniques contained automatic reposition, manual repositioning techniques, re-advancing catheters and catheters' replacement according to different malpositioned patterns.

The most appropriate repositioning techniques should be adopted on the basis of malpositioned locations, direction and length of the malpositioned tip, patients' integrated conditions and available medical equipments to maintain the catheter tip in the best position.

The repositioning techniques described in this review can be applied in clinical practice to ensure the infusion therapy through peripherally inserted central catheter more economical and safe.