TRANSFEMORAL REPOSITIONING OF MALPOSITIONED CENTRAL VENOUS CATHETERS

Purpose: To determine the efficacy of the transfemoral vein approach t o repositioning malpositioned central venous catheters. Methods: Durin g a 4 1/2-year period, malpositioned central venous catheters were rep ositioned 91 times in 83 patients via the transfemoral vein approach. All repositioning was initially attempted with a Grollman catheter or other pigtail catheter and a tip-deflecting wire. If these techniques failed or the venous anatomy was unfavorable, gooseneck or long loop s nares were used. Results: During 48 repositionings, rotating a pigtail -type catheter alone was used successfully in 39 (81%). In 6 of 9 fail ures, the addition of a tip-deflecting wire also failed. A Grollman ca theter and tip-deflecting wire were used initially in 39 repositioning s (6 failures; 85% success), Successful repositioning required a snare in 8 (4 as the primary repositioning technique) and a long-loop techn ique in 5, All repositionings were ultimately successful and there wer e no complications. Conclusion: Central venous catheters can be reposi tioned consistently by the transfemoral route. Pigtail catheters or ti p-deflecting wires alone are successful in over 80% of cases.