Effectiveness of techniques for repositioning peripherally inserted central catheters in newbornsABSTRACT
Objective: To evaluate the effectiveness of techniques for repositioning peripheral insertion central catheters in newborns.
Method: A quasi-experimental study was conducted in a Neonatal Intensive Care Unit at a hospital in southern Brazil between June and September 2023, involving 32 catheters. Combined repositioning techniques were applied, depending on the location of the catheter: traction, elevation of the decubitus position, rapid infusion of saline solution, movement of the upper limbs, and neck. Descriptive analysis was used. The technique was effective when the catheter moved to the cavoatrial junction.
Results: Intracardiac and contralateral subclavian catheter positions were predominant. In 24 cases, the techniques were effective on the first attempt at repositioning; in six cases, the catheters migrated to the cavoatrial junction after the second maneuver; and in two cases, the techniques were not effective.
Conclusion: Catheters with tips in large vessels were successfully repositioned; for those that were angulated or coiled in smaller veins, the maneuvers were less effective.
DESCRIPTORS:
Newborn; Catheters; Central Venous Catheterization; Vascular Access Devices; Neonatal Intensive Care
HIGHLIGHTS
Reduces exposure to new procedures.
May help reduce complications.
Premature patients benefit from these techniques.
Catheter tips in large vessels are easier to reposition.
RESUMO
Objetivo: avaliar a eficácia das técnicas de reposicionamento do Cateter Central de Inserção Periférica em recém-nascidos.
Método: estudo quase experimental, em uma Unidade de Terapia Intensiva Neonatal de um hospital da Região Sul do Brasil, entre junho e setembro de 2023, com 32 cateteres. Aplicaram-se técnicas combinadas de reposicionamento, a depender do local do cateter: tração, elevação do decúbito, infusão rápida de solução fisiológica, movimentação dos membros superiores e pescoço. Utilizou-se análise descritiva. A técnica foi eficaz quando o cateter se deslocou para a junção cavo-atrial.
Resultados: posição dos cateteres intracardíacos e em subclávia contralateral à inserção foram predominantes. Em 24 casos, as técnicas foram eficazes na primeira tentativa de reposicionamento, em seis situações os cateteres migraram para a junção cavo-atrial após a segunda manobra, e em dois cateteres, as técnicas não foram eficazes.
Conclusão: cateteres com ponta em grandes vasos foram reposicionados com êxito, àqueles acotovelados ou enrolados em veias de menor calibre, as manobras foram menos eficazes.
DESCRITORES:
Recém-Nascido; Catéteres; Cateterismo Venoso Central; Dispositivos de Acesso Vascular; Terapia Intensiva Neonatal
HIGHLIGHTS
Reduz a exposição a novos procedimentos.
Pode auxiliar na redução de complicações.
Pacientes prematuros são beneficiados com as técnicas.
Ponta de cateter em vasos calibrosos reposicionam mais facilmente.
RESUMEN
Objetivo: evaluar la eficacia de las técnicas de reposicionamiento del catéter central de inserción periférica en recién nacidos.
Método: estudio casi experimental, en una Unidad de Terapia Intensiva Neonatal de un hospital de la región sur de Brasil, entre junio y septiembre de 2023, con 32 catéteres. Se aplicaron técnicas combinadas de reposicionamiento, dependiendo de la ubicación del catéter: tracción, elevación del decúbito, infusión rápida de solución fisiológica, movimiento de las extremidades superiores y del cuello. Se utilizó un análisis descriptivo. La técnica fue eficaz cuando el catéter se desplazó hacia la unión cavoatrial.
Resultados: la posición de los catéteres intracardiacos y en la subclavia contralateral a la inserción fue predominante. En 24 casos, las técnicas fueron eficaces en el primer intento de reposicionamiento, en seis situaciones los catéteres migraron a la unión cavoatrial tras la segunda maniobra y, en dos catéteres, las técnicas no fueron eficaces.
Conclusión: los catéteres con punta en vasos grandes se reposicionaron con éxito, mientras que en aquellos que se doblaron o se enredaron en venas de menor calibre, las maniobras fueron menos eficaces.
DESCRIPTORES:
Recién Nacido; Catéteres; Cateterismo Venoso Central; Dispositivos de Acceso Vascular; Terapia Intensiva Neonatal
HIGHLIGHTS
Reduce la exposición a nuevos procedimientos.
Puede ayudar a reducir las complicaciones.
Los pacientes prematuros se benefician de estas técnicas.
Las puntas de catéter en vasos calibrados se reposicionan más fácilmente.
INTRODUCTION
The Peripherally Inserted Central Catheter (PICC) is a central venous access obtained from peripheral or deep puncture of the venous network, whose catheter migrates through the anatomical flow to the lower third of the superior vena cava or to the Cavo-Atrial Junction (CAJ)1.
Used in Neonatal Intensive Care Units (NICUs) as a long-term venous access, the PICC has the following indications: antibiotic therapy or infusion solutions for seven days or more, vesicant or irritating solutions (extreme pHs), hyperosmolar solutions (greater than 900mOsm/L) and vasoactive drugs,1 in addition to preservation of the venous network, given the reduction in peripheral punctures2.
Despite its advantages, the use of PICC is not without local complications such as phlebitis, infection, and thrombosis, as well as systemic complications such as septicemia and pulmonary embolism. In addition, circumstantial complications may occur during its stay, such as obstruction, rupture, difficulty in removing the catheter, and poor tip positioning when the PICC is located outside the CAJ2-3.
The off-center location of the tip may prevent or limit its use, given the possibility of the tip lodging in peripheral vessels or cardiac chambers, with a high risk of extravasation, arrhythmias, hypotension, increased central venous pressure, and cardiac tamponade. When malpositioning is identified, nurses must use resources to ensure continuity of care for the newborn and make assertive decisions on how to manage it, optimizing the insertion already performed and reducing the need for new procedures in the newborn. Before indicating removal of the poorly positioned catheter, it is possible to use non-invasive repositioning techniques to move its tip to the CAJ or to the lower portion of the superior vena cava, if inserted in the scalp, jugular, or upper limbs, or to the upper portion of the inferior vena cava, if inserted in veins of the lower limbs.
These techniques are performed by moving the newborn’s limb, infusing saline solution, manually pulling the catheter, or waiting for the catheter to migrate spontaneously with blood flow, depending on the type of location. These techniques are considered safe and important for increasing the cost-effectiveness of the insertion already performed. However, scientific evidence on the clinical application of PICC repositioning techniques, especially in the neonatal population, is limited4.
Different techniques can be used, depending on factors such as the PICC insertion vein, the initial location of the tip, and the patient’s stability. The catheter shifts to the central position due to movements within the venous system after the repositioning techniques are applied1. Given this, the objective of this study was to evaluate the effectiveness of PICC repositioning techniques in newborns (NBs).
METHOD
This is a quasi-experimental study in which the intervention consisted of applying repositioning techniques according to the location of the catheter tip. The outcome was assessed by the migration of the PICC tip to the CAJ or lower portion of the superior vena cava, in cases of insertion into the scalp, jugular vein, or upper limbs, or to the upper portion of the inferior vena cava, in cases of insertion into veins of the lower limbs.
The central location of the catheter, in the anatomy mentioned, was classified according to the definition of the Infusion Nursing Society (INS)1. The outcome was assessed by chest X-ray imaging, and the technique was considered effective in cases where the catheter moved to the central position and ineffective when it migrated to other non-central vessels or did not move in the venous network. A limit of up to three interventions per catheter was established; in unsuccessful cases, the care team made the decision regarding care for the patient with a catheter, according to the routine already established at the research site.
Data collection took place between June and September 2023, with patients admitted to a 30-bed NICU at a university hospital in the state of Paraná. Of these, 10 beds are in the NICU, 15 beds are in the Neonatal Intermediate Care Unit (NICUco), and five beds are in the Kangaroo Neonatal Intermediate Care Unit (NICUka).
The sample was determined based on the estimated prevalence of PICC malposition in the unit, which was 33% of catheters inserted between June and September 2022, the period corresponding to data collection, as well as based on scientific literature, which reports a 25.7%2 to 35.1% occurrence of malposition among inserted PICCs. Given this, a sample of 30 catheters was estimated.
The sample consisted of 32 patients admitted to the NICU, using 32 PICCs, who met the inclusion criterion of having a poorly positioned PICC on chest and abdominal X-ray images. The following were established as exclusion criteria: incomplete completion of the research instrument and unavailability of imaging exams.
The PICC repositioning techniques were based on scientific literature, and nurses qualified to insert the PICC were trained prior to data collection. For this purpose, a PowerPoint® presentation was used, and a practical guide containing the repositioning techniques according to the location of the catheter tip was made available in printed format and via Quick Response Code (QR Code).
At the study site, nurses used the blind direct puncture insertion technique in accordance with routine practice. The anatomical measurement for catheter insertion was taken from the puncture site to the right sternoclavicular space in the case of the upper limbs, scalp, and jugular vein. For the lower limbs, the anatomical reference was puncture site to the inguinal region, umbilical scar to the xiphoid process.
The techniques used for repositioning, depending on the location of the catheter tip, were as follows: traction of PICC with intracardiac tip, based on the assessment of chest X-ray length; elevation of the patient’s head between 30°-45° for 30 minutes; rapid infusion of saline solution according to the patient’s weight; abduction and adduction movements of the shoulder in which the PICC was inserted, and extension of the elbow; lateralization/extension of the neck, according to the need to mobilize the catheter for proper repositioning5-8.
The volume of saline solution for rapid infusion was 1 mL per kilogram, as identified in the scientific literature. In addition, this volume was discussed with the coordinating physician of the NICU at the study site to ensure it was appropriate for the patients’ clinical profiles. The techniques were applied individually or in combination, depending on the type of catheter malposition identified in each patient.
For data collection, an instrument was used that was designed with information about the patients’ profiles, as well as variables related to the techniques to be applied, such as identification of the insertion vein, the initial and final location of the catheter tip, and the ventilation mode used by the patient.
Descriptive data analysis was performed using absolute (number) and relative (percentage) frequencies. The data were stored and analyzed using Microsoft Office Excel® spreadsheets, and the radiographic images were stored for analysis.
The outcome variable that defined the effectiveness of the techniques was the repositioning of the catheter to the CAJ or to the superior or inferior vena cava, identified by radiography performed immediately after the repositioning technique.
Regarding ethical principles, the research was conducted under Resolution No. 466, dated December 12, 2012, of the National Health Council, and approved by the institution’s Research Ethics Committee (REC), having been approved under Opinion 6.159.325. The parents/guardians of hospitalized patients with poorly positioned PICC lines were invited to participate in the study, and, after acceptance, the Free and Informed Consent Term (FICT) was applied.
RESULTS
The study sample consisted of 32 PICCs used in 32 newborns. Of these, 14 (43.7%) were moderately premature, with a gestational age of 31 to 36 weeks, 10 (31.3%) were extremely premature, born between 24 and 30 weeks, and eight (25%) were full-term. The average weight of the newborns was 1,573 grams, ranging from 540 to 4,660 grams, as shown in Table 1.
Regarding ventilatory support, most newborns used some type. Ten (31.25%) were on mechanical ventilation, 10 (31.25%) on Continuous Positive Airway Pressure Bubble (CPAP Bubble), three (9.4%) on Nasal Intermittent Positive Pressure Ventilation (NIPPV), and three (9.4%) on Continuous Positive Airway Pressure (CPAP) (Table 1).
The average length of stay at the time of catheter insertion was 9.3 days, ranging from 1 to 63 days. The indication for the PICC was predominantly the use of antibiotic therapy associated with Total Parenteral Nutrition (TPN), representing 11 (34.4%) of the participants, followed by exclusive TPN in nine (28.1%) cases and antibiotic therapy alone in nine (28.1%) of the indications, as shown in Table 2.
Regarding the catheter insertion vein, nine (28.1%) insertions were observed in the left basilic vein. Regarding poor catheter tip positioning, 18 (56.25%) were located in an intracardiac position, and four (12.5%) were in the contralateral subclavian vein (Table 2).
In 24 cases, the techniques were effective on the first attempt at repositioning; in five situations, the catheters migrated to the CAJ after the second maneuver; and in two cases, the techniques were not effective.
Repositioned with only one maneuver: the four catheters positioned in the contralateral subclavian vein, two coiled in the jugular vein, 15 intracardiac, one coiled in the axillary vein, and two coiled in the subclavian vein.
In one of the cases where the PICC tip was located in the subclavian vein, after the maneuver, it was positioned in the jugular vein due to reflux. Therefore, a new maneuver was performed, with which the catheter migrated to the CAJ. Table 1 shows the positions in which a single maneuver attempt was sufficient to reposition the catheter, while Table 2 describes the other positions and the respective maneuvers with their final outcomes.
Table 3 shows some of the X-ray images before and after the repositioning maneuvers.
X-ray images before and after the application of PICC tip repositioning maneuvers. Curitiba (PR), Brazil, 2023
DISCUSSION
This study’s results showed that the repositioning technique was effective in the majority of cases, with repositioning occurring on the first attempt. With regard to the sample studied, the findings converge with those found in the literature. In a study carried out in Belo Horizonte, Minas Gerais, the NBs who used the PICC were predominantly premature infants between 29 and 36 weeks of GA at the time of insertion, weighing between 1001 and 200 grams2.
The identification of a majority of premature infants in samples using the PICC is common, given their need for infusion therapy to supply their organic and nutritional functions during their stay in the ICU until they are fully matured9-11. This infusion therapy is predominantly based on the use of antibiotics due to immune immaturity, invasive therapeutic procedures, and TPN used until the gastrointestinal tract matures2.
In addition, invasive and noninvasive mechanical ventilation is frequently used in the treatment of prematurity due to pulmonary immaturity. This can cause increased intrathoracic pressure and influence catheter placement and repositioning. One study showed that the patient’s greater clinical severity and the difference in venous flow caused by mechanical ventilation are factors that contribute to inadequate catheter tip placement.
After PICC insertion, assessment of catheter tip positioning is essential to maintain patient safety. The literature reports failure rates in the initial proper positioning of neonatal PICCs ranging from 25.7% to 39.4%2-10. If the catheter tip is poorly positioned, repositioning techniques are recommended1. A literature review that included studies evaluating catheter position and migration after insertion demonstrates techniques that can modify its positioning4.
There was a higher incidence of malpositioning in the left basilic vein, which may be because it is a large vein and consequently one of the first chosen for catheter insertion. Similarly, because it is a longer route, this vein may be preferred by nurses, who adjust the catheter cut according to the route: first punctures are carried out in more distant locations, and then in locations with shorter routes, as seen in the service where the study was carried out. However, as it is located in the left limb, the route is longer, which increases the chances of adverse events14. In addition, there are recommendations for preferential insertion in the right upper limb, in the basilic vein, to reduce the chances of complications15.
Combined PICC repositioning techniques were used in this study. The use of gravity by raising the head of the bed is a method that favors the migration of the catheter into the vessel with the blood flow. Natural changes in intrathoracic pressure allow the catheter to move within the vessel, due to the size and flow dynamics of the vessel13. Thus, as seen in this study, elevating the headboard, combined with other maneuvers, favored the migration of the PICC into the superior vena cava.
In a study carried out using upper limb movements, it was possible to identify body positions that direct the catheter towards the central position and others that move it away from this position, depending on the insertion vein. In this way, these positions contribute to the repositioning of the catheter tip6.
Catheters inserted into the basilic vein: shoulder adduction and elbow flexion direct the catheter to the central position, while shoulder abduction and elbow extension move it to the peripheral position. In the context of the cephalic vein, shoulder abduction and elbow flexion direct the catheter to the central region, while shoulder adduction and elbow extension move it to the periphery. In the case of catheters inserted into the axillary vein, shoulder adduction directs it to the central position, shoulder abduction to the periphery, and elbow movements have no effect6.
In this study, when the catheters had their tips angled or rolled into the blood vessels, we opted for limb movement because this technique is capable of directing the catheter to the periphery6 and enabling alignment within the vessel. Associated with the infusion of saline solution, it facilitates migration to the central vessel when the patient is positioned.
Aspects that may favor the migration of the catheter tip from the jugular vein and contralateral subclavian vein to the central position include the fact that the jugular vein has no venous valves and the blood flow has vibrations that, when the limbs move, help to spontaneously reposition the catheter to the CAJ16.
Another movement applied in the study was neck lateralization in two situations: when the catheter tip was lodged in the axillary vein and in the internal jugular vein ipsilateral to the PICC insertion. In the first case, the aim was to reduce the lumen of the jugular vein and limit the chances of the catheter migrating from the axillary vein to the jugular vein. This movement induces the catheter to migrate into the vena cava. In a study of PICCs inserted in the right upper limb, the researchers kept the arm abducted 90° from the patient’s body and the head turned to the side ipsilateral to the insertion of the device to reduce the chances of the catheter migrating into the internal jugular vein17.
In the second case, the neck movement used in this study was in situations where the PICC inserted in the upper limb was lodged in the jugular vein. In this context, the neck was rotated to the opposite side of the insertion vein, as the aim was to keep the jugular open and apply an adjuvant technique (infusion of saline solution) to make the catheter migrate into the vena cava. In both cases, it was found that the movement contributed to the purpose of the application.
The positioning of the intracardiac PICC was the most prevalent type of inappropriate PICC position. In this regard, one of the precautions prior to inserting the PICC is to measure the limb to be punctured. The data showed a variation of 1 to 5 excess centimeters (intracardiac), requiring traction and persisting from 1 to 2 cm in some cases. The average weight of 1,573 grams of the patients included in the sample is a predisposing factor to intracardiac catheter placement, due to the small size of the patient, in which small fractions of catheter length are able to make it long. This contributes to the high rate of intracardiac PICC placement.
In addition, a study was identified in the scientific literature that adapted the anatomical measurement technique for PICC insertion for premature NBs, taking into account the characteristics of this population18. Traditionally, anatomical landmarks are measured from the puncture point for catheter insertion to the right sternoclavicular space, up to the third right intercostal space, which measurement is used at the data collection site. The adapted proposal determines the measurement from the puncture site to the right sternoclavicular space, without advancing to the third intercostal space. The modified measurement technique for veins in the scalp and upper limbs proved to be more effective, minimizing the occurrence of intracardiac positioning18.
Another technique used in this study was the rapid infusion of saline solution to direct the catheter tip to the central position. In line with this research, another study, using a protocol based on scientific evidence for four months, infused a power flush (saline solution), which resulted in successful repositioning in most cases. The study demonstrated an alternative to previous practices, extending the time the catheter remained in place, reducing delays in treatment and unnecessary procedures, and showing significant savings for the institution19.
We believe that further studies need to be carried out on this subject, and that information on catheter tip repositioning procedures needs to be systematized in order to encourage the use of care technologies that avoid new procedures. Despite the relevance of this study, the sample size does not allow the data to be generalized.
It is believed that the use of technologies with immediate images, such as bedside ultrasound or ultrasound-guided puncture, can help to reposition the catheter during insertion. However, despite the existing technologies, many hospitals rely exclusively on radiography as the method for locating PICCs, and this results in higher rates of post-insertion repositioning4. Therefore, repositioning techniques after insertion become relevant.
A limitation is the diversity of positions in which the tips could be found, limiting the sample to each bad position.
FINAL CONSIDERATIONS
In this study, the techniques for repositioning the PICC catheter in neonates proved to be effective in cases of malpositioning in the contralateral subclavian vein, intracardiac vein, coiled in the jugular vein, coiled in the axillary vein, catheter coiled in the subclavian vein, and less effective in cases of nudging, regardless of the location.
Further studies on this subject are essential in order to increase the quality and safety of neonatal care, as well as rationalizing nursing work, with greater dedication to other activities aimed at the development of NBs, reducing the number of invasive procedures, and cutting hospital costs.
References
-
1 Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs [Internet]. 2021 [cited 2024 Aug 12];44(1S):S1-S224. Available from: https://doi.org/10.1097/nan.0000000000000396
» https://doi.org/10.1097/nan.0000000000000396 -
2 Silveira TVL, Madeira LM, Rigo FL, da Cunha AC, Costa MF, Camponêz PSP, et al. Complicações decorrentes do uso do cateter central de inserção periférica (PICC) em uma unidade de terapia intensiva neonatal. Braz J Dev [Internet]. 2021 [cited 2024 Aug 12];7(10):95180-91. Available from: https://doi.org/10.34117/bjdv7n10-027
» https://doi.org/10.34117/bjdv7n10-027 -
3 Costa JTBA, Matias KC, França VG, Guimarães LC, Beinner MA, de Oliveira SR. Nursing perceptions and practices in relation to adverse events related to peripherally inserted central catheters in neonates: a mixed methods study. J Neonatal Nurs [Internet]. 2024 [cited 2024 Aug 12];30(6):649-53. Available from: https://doi.org/10.1016/j.jnn.2024.03.007
» https://doi.org/10.1016/j.jnn.2024.03.007 -
4 Hagen BM, Meier MJ, Dos Santos GS, Oliniski SR, Matos EVM. Technologies for maintenance of Peripherally Inserted Central Catheterin neonates: an integrative review. Rev Enferm UFSM [Internet]. 2023 [cited 2024 Aug 12];13:e4 Available from: https://doi.org/10.5902/2179769270594
» https://doi.org/10.5902/2179769270594 -
5 de Camargo PP, Kimura AF, Toma E, Tsunechiro MA. Initial placement of the peripherally inserted central catheter’s tip in neonates. Rev Esc Enferm USP [Internet]. 2008 [cited 2024 Aug 12];42(4):719-24. Available from: https://doi.org/10.1590/S0080-62342008000400015
» https://doi.org/10.1590/S0080-62342008000400015 -
6 Nadroo AM, Glass RB, Lin J, Green RS, Holzman IR. Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics [Internet]. 2002 [cited 2024 Aug 12];110(1):131-6. Available from: https://doi.org/10.1542/peds.110.1.131
» https://doi.org/10.1542/peds.110.1.131 -
7 Catudal JP, Sharpe EL. The wandering ways of a PICC Line: case report of a malpositioned Peripherally Inserted Central Catheter (PICC) and correction. JAVA [Internet]. 2011 [cited 2024 Aug 12];16(4):218-20. Available from: https://doi.org/10.2309/java.16-4-3
» https://doi.org/10.2309/java.16-4-3 -
8 Sharpe E, Pettit J, Ellsbury DL. A national survey of neonatal Peripherally Inserted Central Catheter (PICC) practices. Adv Neonatal Care [Internet]. 2013 [cited 2024 Aug 12];13(1):55-74. Available from: https://doi.org/10.1097/ANC.0b013e318278b907
» https://doi.org/10.1097/ANC.0b013e318278b907 -
9 Jantsch LB, Neves ET, Arrué AM, Kegler JJ, de Oliveira CR. Utilização do cateter central de inserção periférica em neonatologia. Rev Baiana Enferm [Internet]. 2014 [cited 2021 Dec 5];28(3):244-51. Available from: https://doi.org/10.18471/rbe.v28i3.10109
» https://doi.org/10.18471/rbe.v28i3.10109 -
10 Rangel RJM, Castro DS, Amorim MHC, Zandonade E, Christoffel MM, Primo CC. Practice of insertion, maintenance and removal of peripheral inserted central catheter in neonates. J Res: Fundam Care Online [Internet]. 2019 [cited 2024 Aug 12];11(2):278-84. Available from: https://doi.org/10.9789/2175-5361.2019.v11i2.278-284
» https://doi.org/10.9789/2175-5361.2019.v11i2.278-284 -
11 Ferreira RP. Tecnologia assistencial para reposicionamento não invasivo de cateter central de inserção periférica em recém-nascido [dissertation on the Internet]. Fortaleza, CE: Universidade de Fortaleza; 2022 [cited 2024 Sep 8]. 123 p. Available from: https://biblioteca.sophia.com.br/terminalri/9575/acervo/detalhe/129286
» https://biblioteca.sophia.com.br/terminalri/9575/acervo/detalhe/129286 -
12 Glauser F, Breault S, Rigamonti F, Sotiriadis C, Jouannic AM, Qanadli SD. Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement. Eur Radiol [Internet]. 2016 [cited 2024 Aug 12];27(7):2843-9. Available from: https://doi.org/10.1007/s00330-016-4666-y
» https://doi.org/10.1007/s00330-016-4666-y -
13 Spencer TR. Repositioning of central venous access devices using a high-flow flush technique - a clinical practice and cost review. J Vasc Access [Internet]. 2017 [cited 2024 Aug 12];18(5):419-25. Available from: https://doi.org/10.5301/jva.5000748
» https://doi.org/10.5301/jva.5000748 -
14 Talari G, Talari P, Parasramka S, Mirrakhimov AE. Recurrent migration of peripherally inserted central catheter into the azygos vein. Case Reports [Internet]. 2018 [cited 2024 Aug 12];2018:bcr-2017-221184. Available from: https://doi.org/10.1136/bcr-2017-221184
» https://doi.org/10.1136/bcr-2017-221184 -
15 Huang C, Wu Z, Huang W, Zhang X, Lin X, Luo Jielin, et al. Identifying the impact of the Zone Insertion MethodTM (ZIMTM): a randomized controlled trial. J Vasc Access [Internet]. 2021 [cited 2024 Aug 12];24(4):729-38. Available from: https://doi.org/10.1177/11297298211052528
» https://doi.org/10.1177/11297298211052528 -
16 Chen W, He L, Yue L, Park M, Deng H. Spontaneous correction of misplaced peripherally inserted central catheters. J Cardiovasc Imaging [Internet]. 2018 [cited 2024 Aug 12];34:1005-8. Available from: https://doi.org/10.1007/s10554-018-1321-5
» https://doi.org/10.1007/s10554-018-1321-5 -
17 Song S, Huh U, Lee JI, Lee CW, Eom JS, Kim HJ, et al. Ipsilateral ultrasound-monitoring technique for reducing malpositions of peripherally inserted central catheters in the intensive care unit. Ann Palliat Med [Internet]. 2021 [cited 2024 Aug 12];10(2):1530-8. Available from: https://doi.org/10.21037/apm-20-1201
» https://doi.org/10.21037/apm-20-1201 -
18 Tomazoni A, Rocha PK, Pedreira MLG, Rodrigues EC, Manzo BF, dos Santos LM. Methods for measuring venous peripherally inserted central catheters in newborns. Rev Bras Enferm [Internet]. 2022 [cited 2024 Aug 12];75(2):e20210045. Available from: https://doi.org/10.1590/0034-7167-2021-0045
» https://doi.org/10.1590/0034-7167-2021-0045 -
19 Mesa J, Mejia A, Tiu G. CE Article: use of an evidence-based protocol for repositioning Peripherally Inserted Central Catheters (PICCs) in children and adultsCE JAVA [Internet]. 2021 [cited 2024 Aug 12];26(1):6-14. Available from: https://www.doi.org/10.2309/JAVA-D-19-00016
» https://www.doi.org/10.2309/JAVA-D-19-00016
-
HOW TO REFERENCE THIS ARTICLE:
Pinto LVD, Kaufmann GW, Giacomozzi CM, Sousa AC, Favero L. Effectiveness of techniques for repositioning peripherally inserted central catheters in newborns. Cogitare Enferm [Internet]. 2025 [cited “insert year, month and day”];30:e97191en. Available from: https://doi.org/10.1590/ce.v30i0.97191en
Source: The authors (2023).