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Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

Roldan CJ, Paniagua L - West J Emerg Med (2015)

Bottom Line: By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English.Of those, we found that 39 were relevant to our objectives and included them in our review.Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas.

ABSTRACT
Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

No MeSH data available.


Related in: MedlinePlus

Common variants of clinical significance in the central venous anatomy, the congenital persistent left-sided superior vena cava.
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f1-wjem-16-658: Common variants of clinical significance in the central venous anatomy, the congenital persistent left-sided superior vena cava.

Mentions: Other experts attribute malpositioning to variations in the venous anatomy. These variations can lead to catheter misguidance into vein tributaries that offer low-resistance routes for the entering catheter tip. Two types of variants in venous anatomy are recognized: congenital and acquired. In patients with CVCs, congenital variations are usually discovered incidentally on imaging after CVC placement.11 Although these variations are usually asymptomatic, they can make the radiologic location of the CVC tip difficult to discern. A common congenital variation with clinical significance is a persistent left-sided SVC (Figure 1 and 2), which is seen in 0.3% of healthy patients and 4.3% of patients with congenital heart disease.12,13 Other relevant congenital variations in venous anatomy include a dominant supreme (highest) intercostal venous drainage to the hemiazygos vein, dextrocardia, inferior vena cava variations, partial anomalous pulmonary venous drainage, and azygos vein abnormalities in origin, course, tributaries, anastomoses, and termination.14


Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

Roldan CJ, Paniagua L - West J Emerg Med (2015)

Common variants of clinical significance in the central venous anatomy, the congenital persistent left-sided superior vena cava.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644031&req=5

f1-wjem-16-658: Common variants of clinical significance in the central venous anatomy, the congenital persistent left-sided superior vena cava.
Mentions: Other experts attribute malpositioning to variations in the venous anatomy. These variations can lead to catheter misguidance into vein tributaries that offer low-resistance routes for the entering catheter tip. Two types of variants in venous anatomy are recognized: congenital and acquired. In patients with CVCs, congenital variations are usually discovered incidentally on imaging after CVC placement.11 Although these variations are usually asymptomatic, they can make the radiologic location of the CVC tip difficult to discern. A common congenital variation with clinical significance is a persistent left-sided SVC (Figure 1 and 2), which is seen in 0.3% of healthy patients and 4.3% of patients with congenital heart disease.12,13 Other relevant congenital variations in venous anatomy include a dominant supreme (highest) intercostal venous drainage to the hemiazygos vein, dextrocardia, inferior vena cava variations, partial anomalous pulmonary venous drainage, and azygos vein abnormalities in origin, course, tributaries, anastomoses, and termination.14

Bottom Line: By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English.Of those, we found that 39 were relevant to our objectives and included them in our review.Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Health Science Center, Department of Emergency Medicine, Houston, Texas.

ABSTRACT
Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

No MeSH data available.


Related in: MedlinePlus