Chest x-ray: PICC position (summary)

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This is a basic article for medical students and other non-radiologists

Chest x-ray PICC (peripherally inserted central catheter) position should be assessed following initial placement and on subsequent radiographs.

Reference article

This is a summary article; we do have a more in-depth reference article PICC.

Summary

  • insertion
    • usually inserted via the antecubital fossa
    • threaded proximally without image guidance
    • chest x-ray performed afterwards to check position
    • tip should sit at the superior cavoatrial junction
  • assessing position
    • window the image to best visualize the line
    • trace the line from its insertion up the arm towards the axilla
    • trace the line under the clavicle towards the SVC
    • trace the line towards the heart
      • ensure that the line does not turn cranially
    • visualize the tip of the line
      • tip should be at the cavoatrial junction
    • document the position of the line
  • potential malposition
    • tip too high: proximal SVC
    • tip too low: distal right atrium or right ventricle
    • tip in the right internal jugular vein
    • tip in the azygos vein
    • coiled in the axillary/subclavian vein
  • possible complications
    • tip too high: increased risk of thrombus formation
    • tip too low: increased risk of arrhythmia
Medical student radiology curriculum