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The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.

Pikwer, Andreas LU ; Bååth, Lars LU ; Davidson, B; Perstoft, I and Åkeson, Jonas LU (2008) In Anaesthesia and Intensive Care 36(1). p.30-37
Abstract
Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical... (More)
Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Anaesthesia and Intensive Care
volume
36
issue
1
pages
30 - 37
publisher
Australian Society of Anaesthesists
external identifiers
  • PMID:18326129
  • WOS:000253519300006
  • Scopus:38949121922
ISSN
0310-057X
language
English
LU publication?
yes
id
f4f85555-f5ca-4480-8ed6-e418dda36ef1 (old id 1052760)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18326129?dopt=Abstract
date added to LUP
2008-04-02 16:38:51
date last changed
2016-11-06 04:28:46
@misc{f4f85555-f5ca-4480-8ed6-e418dda36ef1,
  abstract     = {Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.},
  author       = {Pikwer, Andreas and Bååth, Lars and Davidson, B and Perstoft, I and Åkeson, Jonas},
  issn         = {0310-057X},
  language     = {eng},
  number       = {1},
  pages        = {30--37},
  publisher    = {ARRAY(0xa203f18)},
  series       = {Anaesthesia and Intensive Care},
  title        = {The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.},
  volume       = {36},
  year         = {2008},
}