Introduction Literature search Mechanisms of cvc malpositioning Preventing malpositioning Identifiying malpositioning through signs and symptoms Confirming malpositioning using imaging Fixing malpositioning Conclusion Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. Diagnostic and interventional radiology in central venous access. The objectives of this review were to characterize the factors associated with neck and thorax CVC malpositioning and to offer ways of preventing, identifying, and correcting this error. Central venous catheter malposition presenting as chest pain.
Indeed, it has been radiographically demonstrated that the catheter tip can significantly move up cephalad, from mid-right atrium to low SVC, when the patient sits up; this migration was greater for CVC placed in the subclavian veins in females and in obese patients.
In other settings, CVCs are used to provide access for hemodialysis, transvenous heart pacing, and monitoring of hemodynamics by measuring central filling pressure and cardiac output.
CVC placement requires training and experience and is not without risk for patients, even when performed by skilled professionals.
The most common adverse events associated with neck and thorax CVC insertion have been extensively addressed in the literature and include infection (5% to 26%), hematoma (2% to 26%), and pneumothorax (up to 30%).
A less commonly described yet important complication of CVC placement is malpositioning of the tip of the CVC in a vessel other than the superior vena cava (SVC).
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The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning.