This is a basic article for medical students and other non-radiologists
Chest x-ray PICC (peripherally inserted central catheter) position should be assessed following initial placement and on subsequent radiographs.
Reference article
This is a summary article; we do have a more in-depth reference article PICC.
Summary
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insertion
- usually inserted via the antecubital fossa
- threaded proximally without image guidance
- chest x-ray performed afterwards to check position
- tip should sit at the superior cavoatrial junction
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assessing position
- window the image to best visualize the line
- trace the line from its insertion up the arm towards the axilla
- trace the line under the clavicle towards the SVC
- trace the line towards the heart
- ensure that the line does not turn cranially
- visualize the tip of the line
- tip should be at the cavoatrial junction
- document the position of the line
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potential malposition
- tip too high: proximal SVC
- tip too low: distal right atrium or right ventricle
- tip in the right internal jugular vein
- tip in the azygos vein
- coiled in the axillary/subclavian vein
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possible complications
- tip too high: increased risk of thrombus formation
- tip too low: increased risk of arrhythmia