Displacement of catheters inserted through internal jugular veins with neck flexion and extension

Abstract

Displacement of central venous catheters inserted through internal jugular veins in adult man was estimated on chest x-rays in six patients and measured in six corpses. The downward displacement of the catheter tips with maximum neck flexion varied between 1.0 and 2.0 cm in patients, and between 1.0 and 2.5 cm in corpses. The upward displacement with maximum neck extension varied between 0.5 to 1.0 cm in patients and 0.5 to 1.5 cm in corpses. The total displacement varied between 1.5 to 3.0 cm in patients, and 1.5 to 4.0 cm in corpses. The geater displacement in corpses might be explained by detachment of sternocleidomastoid muscles, and by resection of the sternum and anterior ribs, performed for access to the heart and superior vena cava. There was no apparent correlation between the side and site of the vein puncture, body length, sternocleidomastoid length, distances from the punction sites to suprasternal notch, and values of the displacements of the catheter tips in any group. To avoid rhythm disturbances and perforation of the heart (possible complications of the catheter displacement), the necessity of locating central venous catheter tips 3.0 to 4.0 cm above the superior vena cava-right atrial junction, and firm fixation of the catheter is stressed.

Fixation of the short-term central venous catheter. A comparison of two techniques

“…The most common pathway in the pathophysiology of CVC infection is the migration of skin microorganisms from the insertion site through the tunnel created by the insertion of the catheter 24 . The total displacement of the tip of a CVC inserted in a patient during flexion and maximum extension of the head and neck ranges from 1.5 to 3.0 cm 25 . Thus, it was chosen to assess displacements greater than 2 cm with the head in a neutral position relative to the thorax.…”

Complications of central venous catheterization in critically ill children

“…Extravasation secondary to malpositioned proximal lumen of a double‐lumen hemodialysis catheter at the subclavian vein suggests that multiple‐lumen catheters can be partially dislodged by head movement and changes in position even if they were firmly fixed. In adults, subclavian catheters have been shown to move up to 3 cm towards the heart with movement of the head or neck 42,43 . Therefore, repeated aspiration of blood from the most proximal lumen should be performed to detect secondary to central venous catheter dislodgment.…”

“…In adults, subclavian catheters have been shown to move up to 3 cm towards the heart with movement of the head or neck. 42,43 Therefore, repeated aspiration of blood from the most proximal lumen should be performed to detect secondary to central venous catheter dislodgment.…”

Delayed Hydrothorax Following Percutaneous Central Venous Cannulation

“…A combination of Factors probably contributed to vein wall erosion. First, the insecure fixation of the catheter and movement of the head and neck has been shown in volunteers and cadavers to result in a back-and-forth movement of the catheter tip (9). All our catheters were merely taped in place so that such movement of the catheter tips likely did occur as the patients moved about in the postoperative period.…”