{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T20:40:09Z","timestamp":1792874409102,"version":"4.5.0"},"reference-count":11,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,7,1]]},"abstract":"<jats:p>Objective. The migration of peripherally inserted central catheters (PICCs) from the superior or inferior vena cava into the right atrium can pose a significant risk of lethal pericardial effusion and tamponade secondary to myocardial perforation. Arm movement has been reported to cause displacement of the catheter tip toward the heart and lead to ventricular tachycardia in adults. The objective of this study was to investigate whether adduction or abduction at the shoulder and flexion or extension at the elbow affect the position of PICCs placed via upper limb veins. We also hypothesized that arm movements can be used to reposition malpositioned catheters.<\/jats:p>\n               <jats:p>Methods. A total of 280 radiographs of 60 neonates with PICCs inserted via upper limb veins from July 2000 through June 2001 were reviewed. Differences in catheter tip position as a result of abduction versus adduction at the shoulder, flexion versus extension at the elbow, and combination changes in arm posture were determined by measurements in paired radiographs. Correction of malpositioned catheters was attempted in 10 patients by using arm movements without any alterations at the site of insertion.<\/jats:p>\n               <jats:p>Results. Arm movements were associated with significant displacement of catheters. Catheters that were placed via the basilic or axillary vein migrated toward the heart with adduction of the arm, whereas those that were placed via the cephalic vein moved away from the heart with adduction. Flexion of the elbow displaced catheters that were placed in the basilic or cephalic vein below the elbow toward the heart but did not have any effect on catheters that were placed via the axillary vein. For catheters that were placed in the basilic vein, simultaneous shoulder adduction and elbow flexion caused the greatest movement toward the heart (15.11 \u00b1 1.22 mm). We were able to reposition correctly inappropriately placed catheters in 9 of 10 patients by using arm movements.<\/jats:p>\n               <jats:p>Conclusions. Arm movements significantly affect the position of the tip of the PICCs. Prevention of catheter migration into the right atrium requires radiographic determination of vein of insertion and monitoring of catheter tip position with upper extremity in position of maximum inward movement of catheter for that vein. Arm movements can be used to correct the malpositioned catheters.<\/jats:p>","DOI":"10.1542\/peds.110.1.131","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:17:55Z","timestamp":1092442675000},"page":"131-136","source":"Crossref","is-referenced-by-count":108,"title":["Changes in Upper Extremity Position Cause Migration of Peripherally Inserted Central Catheters in Neonates"],"prefix":"10.1542","volume":"110","author":[{"given":"Ali M.","family":"Nadroo","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Newborn Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald B.","family":"Glass","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mount Sinai School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Newborn Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Newborn Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian R.","family":"Holzman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Newborn Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2002,7,1]]},"reference":[{"key":"2021121006183402200_R1","doi-asserted-by":"crossref","unstructured":"Nadroo AM, Lin J, Green RS, Magid MS, Holzman IR. Death as a complication of peripherally inserted central catheters in neonates. J Pediatr.2001;138:599\u2013601","DOI":"10.1067\/mpd.2001.111823"},{"key":"2021121006183402200_R2","doi-asserted-by":"crossref","unstructured":"Rogers BB, Berns SD, Maynard EC, Hansen TW. Pericardial tamponade secondary to central venous catheterization and hyperalimentation in a very low birth infant. Pediatr Pathol.1990;10:819\u2013823","DOI":"10.3109\/15513819009064715"},{"key":"2021121006183402200_R3","unstructured":"Byard RW, Bourne AJ, Moore L, Little KE. Sudden death in early infancy due to delayed cardiac tamponade complicating central venous line insertion and cardiac catheterization. Arch Pathol Lab Med.1992;116:654\u2013656"},{"key":"2021121006183402200_R4","doi-asserted-by":"crossref","unstructured":"Goutail-Flaud MF, Sfez M, Berg A, et al. Central venous catheter-related complications in newborns and infants: a 578-case survey. J Pediatr Surg.1991;26:645\u2013650","DOI":"10.1016\/0022-3468(91)90001-A"},{"key":"2021121006183402200_R5","doi-asserted-by":"crossref","unstructured":"Pesce C, Mercurella A, Musi L, Campobasso P, Negri M. Fatal cardiac tamponade as a late complication of central venous catheterization: a case report. Eur J Pediatr Surg.1999;9:113\u2013115","DOI":"10.1055\/s-2008-1072224"},{"key":"2021121006183402200_R6","doi-asserted-by":"crossref","unstructured":"Kalso E, Rosenberg PH, Vuorialho M, Pietila K. How much do arm movements displace cubital central venous catheter tip?Acta Anaesthesiol Scand.1982;26:354\u2013356","DOI":"10.1111\/j.1399-6576.1982.tb01781.x"},{"key":"2021121006183402200_R7","doi-asserted-by":"crossref","unstructured":"Kasten GW, Owens E, Kennedy D. Ventricular tachycardia resulting from central venous catheter tip migration due to arm position changes: report of two cases. Anesthesiology.1985;62:185\u2013187","DOI":"10.1097\/00000542-198502000-00019"},{"key":"2021121006183402200_R8","doi-asserted-by":"crossref","unstructured":"Bar-Joseph G, Galvis AG. Perforation of the heart by central venous catheters in infants: guidelines to diagnosis and management. J Pediatr Surg.1983;18:284\u2013287","DOI":"10.1016\/S0022-3468(83)80103-1"},{"key":"2021121006183402200_R9","doi-asserted-by":"crossref","unstructured":"Sigurdsson J, Riba P, Sigurdsson SS. The wandering central venous catheter. An unusual case of catheter displacement. Intensive Care Med.1985;11:263\u2013264","DOI":"10.1007\/BF00260361"},{"key":"2021121006183402200_R10","doi-asserted-by":"crossref","unstructured":"Rastogi S, Bhutada A, Sahini R, Berdon WE, Wung JT. Spontaneous correction of the malpositioned percutaneous central venous line in infants. Pediatr Radiol.1998;28:694\u2013696","DOI":"10.1007\/s002470050442"},{"key":"2021121006183402200_R11","unstructured":"Peripherally Inserted Central Catheter: The Selection, Insertion, Use and Care of the First PICC Catheter: Clinical Education Class Manual. Sandy, UT: Becton Dickinson and Company; 1998:29"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/110\/1\/131\/1115029\/pe0702000131.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/110\/1\/131\/1115029\/pe0702000131.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T14:16:49Z","timestamp":1639145809000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/110\/1\/131\/64041\/Changes-in-Upper-Extremity-Position-Cause"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,7,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2002,7,1]]},"published-print":{"date-parts":[[2002,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.110.1.131","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,7,1]]}}}