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Emergency Radiology

, Volume 23, Issue 3, pp 269–273 | Cite as

Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis

  • David H. Ballard
  • Navdeep S. Samra
  • Karen Mathiesen Gifford
  • Robert Roller
  • Bruce M. Wolfe
  • John T. Owings
Original Article

Abstract

Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48 ± 11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p < 0.001) and venous thrombosis (p < 0.001). Patients with femoral catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p < 0.01). In conclusion, to reduce catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible.

Keywords

Central venous catheter Central venous catheter complications Catheter-related thrombosis Catheter-related sepsis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Broviac JW, Cole JJ, Scribner BH (1973) A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 136:602–606PubMedGoogle Scholar
  2. 2.
    Hickman RO, Buckner CD, Clift RA et al (1979) A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 148:871–875PubMedGoogle Scholar
  3. 3.
    McGee DC, Gould MK (2003) Preventing complications of central venous catheterization. N Engl J Med 348:1123–1133CrossRefPubMedGoogle Scholar
  4. 4.
    Ladefoged K, Jarnum S (1978) Long-term parenteral nutrition. BMJ 2:262–266CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Thomas JH, MacArthur RI, Pierce GE, Hermreck AS (1980) Hickman-Broviac catheters. Indications and results. Am J Surg 140:791–796CrossRefPubMedGoogle Scholar
  6. 6.
    Brennan MF (1981) Total parenteral nutrition in the cancer patient. N Engl J Med 305:375–382CrossRefPubMedGoogle Scholar
  7. 7.
    Ducatman BS, McMichan JC, Edwards WD (1985) Catheter-induced lesions of the right side of the heart. A one-year prospective study of 141 autopsies. JAMA 253:791–795CrossRefPubMedGoogle Scholar
  8. 8.
    Sheep RE, Guiney WB (1982) Fatal cardiac tamponade. Occurrence with other complications after left internal jugular vein catheterization. JAMA 248:1632–1635CrossRefPubMedGoogle Scholar
  9. 9.
    Barton BR, Hermann G, Weil R (1983) Cardiothoracic emergencies associated with subclavian hemodialysis catheters. JAMA 250:2660–2662CrossRefPubMedGoogle Scholar
  10. 10.
    Vesely TM (2003) Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 14:527–534CrossRefPubMedGoogle Scholar
  11. 11.
    Food and Drug Administration Task Force (1989). Precautions necessary with central venous catheters. FDA Drug Bulletin 15–16Google Scholar
  12. 12.
    Polderman KH, Girbes ARJ (2002) Central venous catheter use. Part 2: infectious complications. Intensive Care Med 28:18–28CrossRefPubMedGoogle Scholar
  13. 13.
    Gouttebel MC, Saint-Aubert B, Astre C, Joyeux H (1986) Total parenteral nutrition needs in different types of short bowel syndrome. Dig Dis Sci 31:718–723CrossRefPubMedGoogle Scholar
  14. 14.
    Messing B, Crenn P, Beau P et al (1999) Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology 117:1043–1050CrossRefPubMedGoogle Scholar
  15. 15.
    Vargas JH, Ament ME, Berquist WE (1987) Long-term home parenteral nutrition in pediatrics: ten years of experience in 102 patients. J Pediatr Gastroenterol Nutr 6:24–32CrossRefPubMedGoogle Scholar
  16. 16.
    Riella MC, Scribner BH (1976) Five years’ experience with a right atrial catheter for prolonged parenteral nutrition at home. Surg Gynecol Obstet 143:205–208PubMedGoogle Scholar
  17. 17.
    El Boghdadly SA, Cooke T, Russell LD (1983) Prolonged access to the venous system using the Hickman right atrial catheter. Ann R Coll Surg Engl 65:347–348PubMedPubMedCentralGoogle Scholar
  18. 18.
    Kuwahara T, Asanami S, Kubo S (1998) Experimental infusion phlebitis: tolerance osmolality of peripheral venous endothelial cells. Nutrition 14:496–501CrossRefPubMedGoogle Scholar
  19. 19.
    Bayer-Berger M, Chioléro R, Freeman J, Hirschi B (1989) Incidence of phlebitis in peripheral parenteral nutrition: effect of the different nutrient solutions. Clin Nutr 8:181–186CrossRefPubMedGoogle Scholar
  20. 20.
    Davies J, Catton J, Wood J et al (2003) Intravenous nutrition—peripheral or central administration? Br J Surg 90(S):90–91Google Scholar
  21. 21.
    Zochios V, Umar I, Simpson N, Jones N (2014) Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access 15:329–337CrossRefPubMedGoogle Scholar
  22. 22.
    Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11:837–840CrossRefPubMedGoogle Scholar
  23. 23.
    Nifong TP, McDevitt TJ (2011) The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest 140:48–53CrossRefPubMedGoogle Scholar
  24. 24.
    Evans RS, Sharp JH, Linford LH et al (2010) Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 138:803–810CrossRefPubMedGoogle Scholar
  25. 25.
    Krasnow SH, Rhodes G, Boyer M et al (1985) Hickman catheter tip displacement. South Med J 78:1327–1329CrossRefPubMedGoogle Scholar
  26. 26.
    Merrer J, De Jonghe B, Golliot F et al (2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286:700–707CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2016

Authors and Affiliations

  • David H. Ballard
    • 1
  • Navdeep S. Samra
    • 1
  • Karen Mathiesen Gifford
    • 2
  • Robert Roller
    • 2
  • Bruce M. Wolfe
    • 2
    • 3
  • John T. Owings
    • 1
    • 2
  1. 1.Department of SurgeryLouisiana State University Health Sciences Center ShreveportShreveportUSA
  2. 2.Department of SurgeryUniversity of CaliforniaDavisUSA
  3. 3.Department of SurgeryOregon Health & Science UniversityPortlandUSA

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