Internal Jugular Central Venous Catheter Tip Migration: Patient and Procedural Factors

Abstract

Background: The ideal central venous catheter (CVC) tip position placement is controversial, and CVCs do not remain in a fixed position after placement. This study evaluates both patient and procedural factors which may influence CVC tip migration and subsequent catheter dysfunction. Materials and Methods: This study evaluates CVC placements at a single institution. Patient age, gender, body mass index (BMI), catheter laterality, CVC type and indication for central venous access were recorded. Catheter tip location relative to the carina was measured at time of placement and removal utilizing supine fluoroscopic imaging. Patients’ electronic medical records were reviewed for evidence of catheter dysfunction. Statistical analysis was performed utilizing odds ratios and two tailed Student’s t-test. Results: 177 patients were included (101 female; mean age 55; mean BMI 29.2). Catheter types included 122 ports, 50 tunneled large bore central venous catheters (≥9 French), and 5 tunneled small bore central venous catheters (<9 French). 127 were right sided catheters, and 50 were left sided. Left sided CVCs had a mean cranial tip migration of 3.2 cm (standard deviation ±2.9 cm) compared to 0.8 cm (standard deviation ±1.9 cm) for right sided catheters (p = 0.000008). Catheters that migrated cranially by >2 cm had more than 7× greater risk of dysfunction compared to catheters that migrated ≤2 cm (odds ratio of 7.2; p = 0.0001). Left sided CVCs were significantly more likely to have >2 cm of cranial migration (odds ratio 6.9, 95% CI 3.4–14.2, p < 0.0001) and had a higher rate of dysfunction, likely due to this cranial migration (32% vs. 4.7%; p = 0.00001). Gender and BMI were not found to be associated with catheter dysfunction or an increased odds ratio of >2 cm cranial migration. Conclusions: Left-sided CVCs migrate an average of 2.4 cm cranially more than right-sided catheters. Additionally, when migration occurs, left-sided catheters are more likely to be dysfunctional. These suggest that lower initial placement may be beneficial in left-sided catheters.

Asymptomatic Spontaneous Migration of the Tip of Port-A-Cath System Into the Right Internal Jugular Vein: A Case Report of an Uncommon Complication

“…Additionally, physical movement, changes in the body position, neck flexion, congestive heart failure, and high-flow infusion rate may cause such migration [ 6 , 12 , 13 ]. Risk factors such as obesity and female gender did not appear to be associated [ 14 ].…”

Complications of Totally Implantable Central Venous Catheters (Ports) Inserted via the Internal Jugular Vein Under Ultrasound and Fluoroscopy Guidance in Adult Oncology Patients: A Single-Center Experience

“…It is restricted when the procedure is performed under fluoroscopy guidance and the catheter tip is located at the cavoatrial junction or in the proximal right atrium. It is not clear in the literature whether catheter migration is correlated with BMI [ 51 - 53 ]. In our study, where six cases (0.7%, incidence: 0.016/1,000 catheter days) were recorded in women only, no association was revealed.…”

Anästhesiologisches und postinterventionelles Management bei perkutaner hepatischer Melphalanperfusion (Chemosaturation)

“…Intraoperativ muss aufgrund der Okklusion der V. cava inferior und der Nutzung eines venovenösen extrakorporalen Bypasses mit einer ausgeprägten hämodynamischen Instabilität gerechnet werden. Die Okklusion führt, ähnlich wie beim Ausklemmen der V. cava inferior bei Leberteilresektionen oder Lebertransplantationen, zu einer akuten Vorlastsenkung mit schwerer Hypotonie [ 34 , 42 ]. Daher sollte im Rahmen der Patientenevaluation ein besonderes Augenmerk insbesondere auf die kardiale Belastbarkeit der Patienten gelegt werden.…”

“…Die primäre Punktionsstelle ist die rechte V. jugularis interna . Die Doppelpunktion der V. jugularis interna dextra ist erfahrungsgemäß problemlos möglich und bietet durch den anatomischen Gefäßverlauf Vorteile gegenüber der V. jugularis interna sinistra , bei deren Katheterisierung auf eine adäquate Einführtiefe und Spitzenposition im Bereich des kavoatrialen Überganges geachtet werden sollte [ 4 , 42 , 51 , 52 ]. Bei Notwendigkeit einer Punktion der linken V. jugularis interna sollten der längere intravaskuläre Verlauf und das mögliche Risiko von Intimaläsionen bei zu kurzer Einführtiefe des ZVK berücksichtigt werden [ 20 ].…”