Comparison of Catheter Malposition Incidence in Peripherally Inserted Central Catheters Between Left and Right Upper...

This study aims to examine the effects of catheter placement site (left vs. right upper limbs) and operator experience (experienced nurses vs. trainees) on the incidence of peripherally inserted central catheter (PICC) malposition.

A retrospective analysis was conducted on 2451 PICC placements utilizing standardized ultrasound guidance. Malposition was characterized by the catheter tip not in the superior vena cava. In instances of catheter tip excessive insert into cardiac chambers, the distance from the catheter tip to the cavoatrial junction (CAJ) was measured. Propensity score matching (1:1) was employed to control for confounding variables such as age and gender.

The overall malposition rate was 12.32% (302 out of 2451), with no significant difference observed between the limbs (left: 11.58% vs. right: 15.66%, p = 0.018 pre-match; 12.66% vs. 13.70% post-match, p = 0.181). Right-sided placements demonstrated greater catheter penetration (30 mm vs. 16.5 mm into the right heart, p = 0.006). No significant difference in malposition rates was found between experienced nurses and trainees (p > 0.05); however, trainees required more frequent repeat punctures (22.22% vs. 5.05%, p < 0.001).

The rates of PICC malposition are similar between the left and right upper limbs when adjusted for body habitus. However, insertions on the right side pose a higher risk of deeper cardiac placement. The implementation of standardized protocols and the involvement of experienced operators can mitigate procedural complications. These findings advocate for the development of tailored measurement strategies and the enhancement of training programs.