Abstract
Recently, there has been a remarkable increase in the demand for vascular access devices for administration of chemotherapy in patients with head and neck cancers. Peripherally inserted central catheters (PICCs) are reportedly safe and are associated with a low risk of fatal complications during and after implantation; however, only a few reports have focused on the technical procedural aspects of implantation. Herein, we compared the differences in the catheter tip positioning and complications arising after PICC implantation.
We conducted a retrospective analysis of 172 PICC implantations in 145 head and neck cancer patients. PICCs were inserted into the left and right sides in 136 and 36 patients, respectively. The median duration of implantation was 65 days. X-ray data on the catheter tip position during and after catheter insertion were available for 137 implantations in 121 patients. The tip position was defined as follows: Zone A, lower half of the superior vena cava and upper right atrium; Zone B, upper half of the superior vena cava and left brachiocephalic vein; Zone C, left brachiocephalic vein. Zone A and Zone B are considered as being appropriate positions. Among the right-sided implantations, the tip positioning during implantation was proper (Zone A or B) in 33 cases (100%) and the tip position after implantation was proper in 30 cases (91%). Among the left-sided implantations, the tip positioning during implantation was proper in 97 cases (93%) and the tip position after implantation was proper in 82 cases (79%). There was a significant difference in the percentage of patients showing proper catheter tip position between during and after implantation in the case of left-sided implantations (p=0.001), but not in the case of right-sided implantations. Furthermore, there was no significant difference in the incidence of other catheter-related complications.
During implantation, the rate of Zone A placement was lower in left-sided PICC implantations, because of contact of the catheter tip with the right lateral wall of the superior vena cava. Furthermore, after implantation, changes in the body and limb position would also make it difficult for the catheter tip to remain in the appropriate Zone A and B positions in left-sided implantations. Since inappropriate catheter tip position may be a risk factor for delayed superior vena cava wall injury and thrombosis, right-sided PICC implantation is considered to be preferable.
