Efficacy of the CathRite system to guide bedside placement of peripherally inserted central venous catheters in critically ill patients: a pilot study

Critically ill patients in the intensive care unit routinely have a multilumen central venous catheter (CVC) placed as part of management. CVCs facilitate haemodynamic monitoring and infusion of vasoactive medications and hypertonic solutions into the central blood pool. CVCs are commonly inserted via the internal jugular and subclavian veins, and are routinely placed using a “blind” anatomical or ultrasound-assisted technique. Correct positioning is confirmed by routine chest radiography. CVCs have inherent risks of adverse events, including pneumothorax (1.3%–1.5%), neurovascular injury (0.5%–3.0%), bloodstream infections (1.0%–8.6%) and, rarely, cardiac tamponade. 1,2 Specific patient populations are at increased risk of these complications due to their underlying disease (eg, coagulopathy or malignancy). 3 Peripheral vein cannulas are unreliable in critically ill patients, because of oedema and anatomical restrictions, and do not provide long-term multilumen venous access. Peripherally inserted central cannulas (PICCs) have been suggested as an alternative to standard CVCs, and have significantly less risk and lower infection rates, 4 while fulfilling the requirements for multilumen central venous access and haemodynamic monitoring. 5 Traditional radiological placement of PICCs uses fluoroscopy. Standard blind placement via cephalic or basilic arm veins also requires use of chest radiography to determine the catheter position within the great vessels, and carries a risk of ectopic placement. 6 PICC placement at the bedside without radiological control is unreliable, as demonstrated by Cardella et al, 7 who showed that PICC placement was significantly more successful under fluoroscopic control. However, limitations of fluoroscopy, including patient access and radiation exposure, make this technique unsuitable for catheter placements at the bedside in intensive care settings. Furthermore, other authors 8,9 have shown that blind conventional PICC placements are associated with high rates of clinically evident thrombophlebitis, difficult insertion and malposition on insertion. The CathRite system (Micronix Pty Ltd, Adelaide, SA) is a novel, portable device that uses inductive sensing technology, and has the potential to overcome many of the