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Excellent inter-observer agreement between radiologist and nurse: tracheal carina-based identification of peripherally inserted central catheter tip position

Abstract

Introduction

Accurate identification of position of a central venous catheter tip is important to reduce catheter-related complications. Nevertheless, inter-observer bias limits the accuracy of traditional method for determining tip position on chest x-ray (CXR) images. The aim of this study was to explore a simple and objective method for assessing position of peripherally inserted central catheter (PICC) tip on CXR image.

Methods

Tracheal carina was used as the landmark to identify positions of catheter tips. The central vein (CV) was located between 3 cm above and 4 cm below tracheal carina. The vertical distance from catheter tips to tracheal carina was measured independently by a nurse and re-assessed by a radiologist. Inter-observer agreement was expressed as percentage in agreement and kappa coefficient.

Results

Six hundred and twelve CXR images of catheters taken from 612 patients were included. The inter-observer agreement between nurse and radiologist was 97.88% (kappa = 0.934) for all catheter tips evaluated, and 98.40% (kappa = 0.923) for catheter tips with regard to CV, innominate vein, and right atrium. Most discrepancies (9/13) between observers occurred when catheter tips were positioned in a border region between different anatomical parts.

Conclusions

Inter-observer agreement between nurse and radiologist is excellent. Our results demonstrate that the measurement of distance between catheter tip and tracheal carina performed by a nurse provide a convenient and reliable way to determine position of PICC tip. Our study also suggests that nurses can be trained to handle PICCs, especially when properly located catheters are applied in critically ill patients during emergency setting.

Post author correction

Article Type: ORIGINAL RESEARCH ARTICLE

Article Subject: Nursing

DOI:10.5301/jva.5000799

Authors

Xiaoxia Zhang, Dan Jia, Nengwen Ke, Chang Liu, Lan Fu, Xiuying Hu

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

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Authors

Affiliations

  • Tumor Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province - PR China
  • Department of General Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province - PR China
  • Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province - PR China
  • Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province - PR China
  • West China Nursing School, Sichuan University, Chengdu, Sichuan Province - PR China
  • Chang Liu and Xiuying Hu contributed equally to this work.

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