• L Martin, A J Johnston, T C See, and C T Streater.
• John Farman Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. andrew.johnston@addenbrookes.nhs.uk
• Anaesthesia. 2013 May 1;68(5):484-91.

AbstractPeripherally inserted central catheters are increasingly used to provide access to the central venous circulation. They are commonly positioned 'blind' using a variety of anthropometric techniques and operator experience to direct insertion length. Malposition rates are poorly defined because of differing insertion techniques, difficulties defining anatomical tip position on chest radiographs, controversy over what constitutes an adequate catheter position and possible differences between patient groups. We have developed a reproducible method to define catheter positions on chest radiograph and have applied this in a retrospective analysis of 256 ICU and 243 non-ICU catheter insertions over a 6-month period. Two different definitions were used for adequate position. 'Blind' positioning of peripherally inserted central catheters was associated with a definition-dependent malposition rate of 42-76%. Malposition rates were significantly higher in ICU patients. Emerging technologies may assist in reducing these high rates.Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

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