Insertion of peripherally inserted central catheters in an optimum position using skin surgace measurements

Insertion of CVP catheters through internal jugular and subclavian veins has potentially dongerous complications like pneumothorax, arterial puncture, and nerve injury. Using peripherally inserted central catheters (PICC) devoids of these complications. To determine the optimum position of the tip of these catheters, intravenous ECG (IVECG) in used. In this study, we will try to find another technique just by measurement of skin surface distances. In 100 patients undergoing CABG, PICC were inserted using IVECG technique. The position of the catheter tip was determined by surgeon's palpation during operation. The data of the correctly positioned catheters were analysed by SPSS software and two formulae were obtained to measured distances of follow:Insertion length in right arm (cm) = [0.105 * height (cm)] + [0.661 * VJS (cm). Insertion length in left arm (cm) = [0.142 * height (cm)] + [0.599 * VJS (cm). VJS distance was measured between venipuncture site and sternal notch plus 1/3 of the sternal length. In another 40 patients PICC were inserted using the above formulae. The results of catheter insertion using two techniques of IVECG and skin surface measurements are depicted in the table. Position of the catheter tip within 2cm of the junction is an optimum place to measure CVP. There were no significant differences between the two techniques of IVECG and skin surface measurements (p=0.182). So using the above formulae is recommended when using IVECG has limitations or is impossible.