An acceptable predictive formula using pre-procedural chest radiograph for bedside insertion of peripherally inserted central venous catheter (PICC).

Background: Bedside insertion of peripherally inserted central venous catheter (PICC) is still needed in the various clinical settings. For this procedure, the accuracy of predicting the PICC catheter length is important, however, only a few methods have been proposed so far. Purpose: A new formula using pre-procedural chest X ray (pre-CXR) was validated for placing the PICC catheter tip precisely in the actual clinical setting. Material and Methods: The formula predicting the PICC catheter length was formed by the hybrids of the calculated expression in the thorax and the actual measurement of the outer arm. The predicted length in the thorax was based on the half ellipse formed by the three landmarks on the pre-CXR. Prospectively, this formula was applied in the 110 patients. The results were compared to those in the traditional anthropometrical measurements (TAM) in the 48 patients. Results: The discrepancy of the catheter distance from the carina and the variance of the tip position were smaller by using the Formula than by the TAM (P = .00053 and P = .038). Comparing to the other patient's valuables, the Formula had the strongest correlation coefficient with the true PICC length (r = 0.787). Evaluation of validation success showed that the tip position was "optimal" in 79 cases (71.8%) and "suboptimal" in 26 cases (23.6%) in the clinical setting. There were no venous thromboses or catheter occlusions during the catheter placements. Conclusion: This Formula could be acceptable in performing the bedside PICC placement in the real clinical settings.