MIGRATION OF CENTRAL VENOUS CATHETERS - IMPLICATIONS FOR INITIAL CATHETER TIP POSITIONING

PURPOSE: To evaluate the change in position of chest wall central veno us access catheters (CVACs) after placement. Complication rates associ ated with catheter tip position were reviewed. PATIENTS AND METHODS: F ifty patients (36 women, 14 men) with chest wall CVACs placed in the a ngiography suite were studied, Catheter migration was calculated as th e difference between the carina-catheter tip measurements on immediate supine and upright postprocedure (within 24 hours) chest radiographs, Catheter-related complication data were gathered via telephone interv iew and review of the medical records. RESULTS: Peripheral catheter mi gration occurred in 49 of 50 patients (average, 3.2 cm +/- 1.8); centr al catheter migration occurred in one of 50 patients (3.9 cm). Cathete r type was the only significant factor that affected the amount of mig ration; side of insertion or the patient's gender were not significant . Catheter malfunction and symptomatic upper extremity venous thrombos is rates tended to be lower in patients with right atrial versus super ior vena cava catheters (18% vs 34%), but differences were not signifi cant (P = .202). CONCLUSION: Catheter migration after chest wall CVAC placement is a common event. The catheter tip should be initially posi tioned approximately 3-4 cm more centrally than the desired final posi tion. Further study is necessary of catheter-related complication rate s relative to the final position of the catheter tip.