CHANGES IN TUNNELED CATHETER TIP POSITION WHEN A PATIENT IS UPRIGHT

PURPOSE: To determine the relative changes in position of tunneled cat heters from supine to upright patient position and factors affecting c atheter tip migration. MATERIALS AND METHODS: One hundred forty-six di fferent tunneled catheters were placed through the subclavian or jugul ar veins radiologically, and catheter positions were documented with u se of cine radiography at the time of placement, Follow-up chest radio graphs were obtained with the patient in the upright position within 4 8 hours after placement. Catheter tip positions were numbered from 1 t o 8, with 1 representing the innominate/superior vena cava junction sa nd 8, the lower right atrium. Patient sex and weight, the site of cath eter entry, and the size and type of catheter were correlated with the relative change in position on the follow-up chest radiographs. RESUL TS: There was a statistically significant (P < .0001) change in cathet er position on the follow-up chest radiographs, with a mean difference of 1.5 catheter positions (usually mid-right atrium initially to low superior vena cava on follow-up). Catheter tip migration was greater f or catheters in the subclavian veins, in females, and in obese patient s. CONCLUSIONS: The catheter tip migrates significantly from the initi al position at the time of placement as compared to when the patient a ssumes the upright position. This knowledge is important in achieving the desired final catheter position.