Inadequate positioning of central venous catheters inserted at intensive care units

Abstract

Objective: To evaluate the positioning of the distal tip of central venous catheters and the factors that contributed to inadequate positioning in patients admitted to intensive care. Methods: This is a cross-sectional study, with a sample of 246 medical records of patients admitted to intensive care units. A catheter position analysis form was used as an instrument for data collection. Results: It was seen that 86.2% of catheters used in intensive care were centrally inserted in the internal jugular veins, 74.4% were double-lumen catheter, and ultrasound was employed for puncture technique in 84.6% of cases. Of the distal ends of the catheters, 53.7% were at the cavoatrial junction (correct position). According to statistical tests, there was a positive correlation between the inadequate positioning of the distal extremity with the central insertion catheter (p=0.012). Patients with presumptive diagnosis associated with COVID-19 showed a positive correlation with inappropriate positioning of the catheter distal tip (p=0.017). Conclusion: There are extrinsic factors related to improper positioning of the distal tip of catheters, such as the type of catheter used, the patients' diagnosis and the puncture with insertion in the left jugular vein.

Artificial Intelligence to Assess Tracheal Tubes and Central Venous Catheters in Chest Radiographs Using an Algorithmic Approach With Adjustable Positioning Definitions

“…Nevertheless, the algorithmic CVC assessment (in contrast to TTs) is hampered by a less clear and intensively discussed definition of optimal CVC tip positioning, in particular, regarding vertical axis supposed to be optimal below the carina and above the middle of the right atrium where the superior cava vein has its greatest diameter. [33][34][35][36] Taking additional relations to the sternoclavicular joints (horizontal axis) into account, our malpositioning triaging evaluation is based on a target positioning ROI designed for optimally located CVC tips and calibrated by clinical experts (see Figs. 2A, B).…”

Iatrogenic Cardiac Tamponade Secondary to Central Venous Catheter Placement: A Literature Review

“…Central venous catheters are the most common invasive procedure in critical illness treatment that is crucial for the management of most patients who are in the intensive care unit as it can be used for the administration of solutions with high osmolarity, parenteral nutrition, blood transfusion, vasopressors, hemodynamic monitoring, or renal replacement therapy [ 3 ].…”

“…However, ultrasound-guided line insertion is currently the preferred method to decrease the number of complications from this procedure. Still, approximately 20% of insertions are associated with pneumothorax, hemothorax, and thrombosis, among others [ 3 ].…”

“…Nevertheless, cardiac tamponade is an uncommon but fatal complication of centrally inserted venous catheters. This review aims to evaluate and summarize information regarding the characteristics of this complication and provide multiple recommendations to prevent it from happening and management options [ 3 ].…”