Assessing PICC position (basic)

Dr Jeremy Jones et al.
This is a basic article for medical students and other non-radiologists

Assessing PICC (peripherally inserted central catheter) position on a chest x-ray is a common requirement following insertion of the line, prior to its use.

PICCs are usually inserted via the antecubital fossa and threaded towards heart via the axillary vein, subclavian vein and superior vena cava (SVC). The tip should sit at the superior cavoatrial junction, where the SVC and right atrium meet.

If the tip is too high (in the proximal SVC) there is an increased risk of thrombus formation. If the tip is too low (distal right atrium or right ventricle) there is an increased risk of arrhythmia.

The chest x-ray will usually be performed to include the arm into which the PICC has been inserted if the request has included that information.

Process for assessing position

  • window the image to best visualise the line
  • trace the line from its insertion up the arm towards the axilla
  • trace the line under the clavicle towards the SVC
  • ensure that the line does not turn cranially towards the neck vessels
  • trace the line through the right paratracheal soft tissue towards the heart
  • visualise the tip of the line
  • document the position of the line

Potential complications

The main complications from PICC insertion is malplacement of the tip of the catheter:

  • tip in the right internal jugular vein
  • tip in the azygous vein
  • coiled in the axillary/subclavian vein
  • tip too high: proximal SVC
  • tip too low: distal right atrium or right ventricle

Medical student imaging approach
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Article Information

rID: 39663
Systems: Chest, Vascular
Section: Approach
Synonyms or Alternate Spellings:

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