Central Venous Catheters: Do we need to Review Practice on Positioning?

Abstract

It is generally agreed that the tip of an inserted central venous catheter (CVC) should not lie within the right atrium. However, the tip of a CVC not inserted to an adequate depth could lie outside the superior vena cava, predisposing to thrombus formation and infection. A retrospective audit of the position of CVCs on chest radiographs in intensive care patients and the associated incidence of catheter-related infections was therefore undertaken. Chest radiographs of 100 patients who had central venous catheterisation were assessed using the electronic record system, measuring the distance of the CVC tip from the tracheal carina and the site of insertion. Comparisons were then made of the incidence of infection in the groups where the CVC tip was above or below the carina. In a significant proportion of patients (31%) the CVC tip lay too far below the carina. There was no significant difference in the incidence of catheter-related infections between the groups where the catheter was too far below the carina and too far above the carina. CVCs should not be placed too far below the carina as seen on the chest radiograph. Leaving a portion of CVC outside the skin does not appear to increase the incidence of infection in this small group of patients.

A Comparison of the Bow‐Tie and STAMP Approaches to Reduce the Risk of Surgical Instrument Retention

“…(1) There are more than 200,000 CVC insertions annually in the United Kingdom and 6 million in the United States. (2) However, an often overlooked potential complication is the inadvertent total loss travascularly of part of the CVC set-a long, flexible, metal guidewire. Guidewire retention has been reported at a rate of 1 in 3,291 procedures in one medical establishment, (3) although the actual incidence may be even higher due to underreporting.…”

“…CVC is a commonly used medical procedure to gain access to a patient's venous system for a wide range of purposes such as delivering intravenous medication and taking measurements . There are more than 200,000 CVC insertions annually in the United Kingdom and 6 million in the United States . However, an often overlooked potential complication is the inadvertent total loss travascularly of part of the CVC set—a long, flexible, metal guidewire.…”

Folding back of central venous catheter in the internal jugular vein: Methods to diagnose it at the time of insertion?

“…Malpositioning of the tip of the central venous catheter often leads to erroneous measurement, leading to an incorrect volume replacement and other serious complications, like cardiac tamponade or dysrhythmias, caused by the interaction with the wall of the vessel or the endocardium. [1–3]…”

“…The correct position of the tip of CVC should be in the superior vena cava, above the level of pericardial reflection to obtain true CVP measurements. [1] An angle greater than 40° can cause perforation of wall of the blood vessel. [4]…”

Folding Back of Central Venous Catheter in the Internal Jugular Vein: Methods to Diagnose it at the Time of Insertion?

“…The central venous pressure (CVP) monitoring is a useful tool for assessment of the status of intravascular volume. Of the tip of the central venous catheter often leads to erroneous measurement, leading to an incorrect volume replacement and other serious complications, like cardiac tamponade or dysrhythmias, caused by the interaction with the wall of the vessel or the endocardium [1][2][3].…”