MALPOSITION OF CENTRAL VENOUS CATHETERS - INCIDENCE, MANAGEMENT AND PREVENTIVE PRACTICES

Introduction: Proper placement is an essential prerequisite for the us e of central venous catheters. Our study was undertaken to determine t he incidence of aberrant locations dependent on different anatomic app roaches for various types of central venous catheters and to elucidate failures and pitfalls of preventive practices. Methods: 2580 percutan eously inserted lines (including 538 tunneled devices and 112 implanta ble Port-A-Caths) introduced by Seldinger's technique were reviewed fo r inadvertent malpositioning. Results: Primary misplacement was eviden t on 47 occasions (1.82%), 38 times into large venous tributaries of t he superior vena cava. 3 aberrant locations involved a persistent left superior vena cava, two catheters were placed into minor intrathoraci c veins and in 3 patients inadvertent arterial cannulation occurred. T he frequency of malpositioning was related to the anatomic approach an d the catheter type used, but not to the physician's experience, Respe ctive incidences were 4.12% for the left internal jugular access, but were lower for the right internal jugular (1.1%) and the right (1.01%) and left (0.89%) supraclavicular approach. Misplacement was more freq uent with soft silicone catheters (2.53%) than with semi-rigid cathete rs (0.79%). All malpositions but one were detected on chest X-ray, Dis cussion: Our data suggest that the incidence of catheter malposition d epends on the site of insertion, the type of material used, but not on the experience of the physician who inserted the catheter. Scrupulous use of preventive practices reduces the frequency of malpositioned ca theters, but physicians must keep in mind potential pitfalls, Injectio n of radioopaque contrast medium into the catheter during control ches t X-ray should be done even with opaque catheters.