Estimating the insertion length of pediatric peripherally inserted central catheters

Area of Science:

• Pediatric critical care medicine
• Vascular access devices
• Medical imaging and interventional procedures

Background:

• Accurate insertion length of peripherally inserted central catheters (PICCs) is crucial but difficult to determine without fluoroscopy.
• Establishing reliable methods for estimating PICC insertion depth is essential for patient safety in pediatric intensive care units (PICUs).

Purpose of the Study:

• To investigate the correlation between the length from the anterior axillary point to the carina (Lcarina) and patient height.
• To develop and assess simplified formulas for estimating optimal PICC insertion length.

Main Methods:

• Retrospective analysis of PICCs inserted in the upper arm of pediatric patients.
• Utilized linear regression to evaluate the relationship between Lcarina and patient height.
• Performed simulated performance assessments of simplified estimation formulas.

Main Results:

• Significant linear correlations were found between Lcarina and patient height for both right (R²=0.71) and left (R²=0.65) arm PICCs.
• A simplified formula, 0.1 × height (cm) + 1 (cm), predicted correct placement in 93% of right arm and 96% of left arm PICCs.
• The formula indicated expected insertion in the subclavian vein, innominate vein, or superior vena cava.

Conclusions:

• Patient height is a reliable predictor of the carina level, which is a key landmark for PICC insertion.
• A simplified formula using patient height offers a promising, non-invasive method for estimating PICC insertion length.
• Further validation studies are recommended to confirm the clinical utility of the proposed simplified formula.