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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

Portable chest radiograph showing a central line catheter placed on the right subclavian vein. The catheter migrated to the right internal jugular vein despite proper procedural technique. Mild resistance was experienced during the wire threading. The patient had history of chronic renal disease. A hemodialysis catheter had been placed in the right subclavian vein for several months and had been removed recently.
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f3-wjem-16-658: Portable chest radiograph showing a central line catheter placed on the right subclavian vein. The catheter migrated to the right internal jugular vein despite proper procedural technique. Mild resistance was experienced during the wire threading. The patient had history of chronic renal disease. A hemodialysis catheter had been placed in the right subclavian vein for several months and had been removed recently.

Mentions: Acquired variations in venous anatomy are more common than congenital variations and can be external or internal in origin.6 More than 85% of external vessel distortions are caused by compression due to malignancy (often lung cancer, breast cancer, lymphoma, or germ cell tumors). Benign causes of external distortion include substernal goiter, thymoma, cystic hygroma, and histoplasmosis. Also, lung collapse or pleural effusions can shift venous structures such as the SVC away from the midline. Internal vessel distortion can be caused by thrombosis or stenosis. The risk of thrombosis can be increased by recent surgery, malignancy, immobilization, hemodialysis, chemotherapy, and pregnancy, and vessel stenosis has been associated with overuse of any vessel, subclavian cannulation, and central venous access from the left side of the neck.15 (Figure 3).


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

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

Portable chest radiograph showing a central line catheter placed on the right subclavian vein. The catheter migrated to the right internal jugular vein despite proper procedural technique. Mild resistance was experienced during the wire threading. The patient had history of chronic renal disease. A hemodialysis catheter had been placed in the right subclavian vein for several months and had been removed recently.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3-wjem-16-658: Portable chest radiograph showing a central line catheter placed on the right subclavian vein. The catheter migrated to the right internal jugular vein despite proper procedural technique. Mild resistance was experienced during the wire threading. The patient had history of chronic renal disease. A hemodialysis catheter had been placed in the right subclavian vein for several months and had been removed recently.
Mentions: Acquired variations in venous anatomy are more common than congenital variations and can be external or internal in origin.6 More than 85% of external vessel distortions are caused by compression due to malignancy (often lung cancer, breast cancer, lymphoma, or germ cell tumors). Benign causes of external distortion include substernal goiter, thymoma, cystic hygroma, and histoplasmosis. Also, lung collapse or pleural effusions can shift venous structures such as the SVC away from the midline. Internal vessel distortion can be caused by thrombosis or stenosis. The risk of thrombosis can be increased by recent surgery, malignancy, immobilization, hemodialysis, chemotherapy, and pregnancy, and vessel stenosis has been associated with overuse of any vessel, subclavian cannulation, and central venous access from the left side of the neck.15 (Figure 3).

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