Background: Bedside placement of peripherally inserted central catheters (PICCs) may result in navigation to undesirable locations, such as the contralateral innominate or jugular vein, instead of the superior vena cava or right atrium. Although some guidance and tip location tools exist, they have inherent limitations because of reliance on physiological measures (eg, chest landmarks, electrocardiogram, etc), instead of anatomical assessment (ie, geometric changes in the vasculature). In this study, an accurate, anatomically based, non-X-ray guidance tool placed on a novel 0.035" conductance guidewire (CGW) is validated for PICC navigation and tip location. Methods: The CGW system uses electrical conductance recordings to assess changes in vessel cross-sectional area to guide navigation of the PICC tip. Conductance rises and oscillates when going in the correct direction to the superior vena cava/right atrium, but drops when going in the incorrect direction away from the heart. Bench and in vivo studies in six swine were used to confirm the accuracy and repeatability of the PICC placement at various anatomical locations. The PICC tip location was confirmed by direct visualization vs the desired location. Results: CGW PICC guidance was highly accurate and repeatable with virtually no difference between actual and desired catheter tip location. The difference between the CGW PICC location vs the desired target was L0.07 6 0.07 cm (6.6% error) on the bench and 0.04 6 0.10 cm (5% error) in vivo. No complications or adverse events occurred during CGW usage. Conclusions: The CGW provides an anatomically based, reproducible, and clinically significant method for PICC navigation and tip location that can improve accuracy, decrease the wait time prior to therapy delivery, decrease cost, and minimize the need for X-ray. These findings warrant clinical evaluation of this navigation tool for PICC line placement. (J Vasc Surg: Venous and Lym Dis 2013;1:202-8.) Clinical Relevance: This paper describes impedance technology (a conductance guidewire [CGW]) utilized as a new platform for accurate peripherally inserted central catheter (PICC) line delivery. The CGW has the ability to function as a standard platform for over-the-wire delivery and acts as a novel system for device navigation without the need for fluoroscopy or X-ray. Ultimately, the CGW described here is clinically relevant, as it provides an accurate, anatomically relevant, and reproducible method for PICC delivery that can improve accuracy, decrease the wait time prior to therapy delivery, decrease cost, and minimize X-ray exposure for both patients and clinicians.
|Original language||English (US)|
|Journal||Journal of Vascular Surgery: Venous and Lymphatic Disorders|
|State||Published - Apr 2013|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine