The importance of ideal central venous access device tip position

Abstract

The use of central venous access devices (CVADs) is becoming more common in hospitals and the community. Incorrect tip placement is a common complication of CVAD insertion carried out at the bedside, and can lead to local inflammation and thrombosis. The literature recommends that a CVAD tip should be in the lower third of the superior vena cava. Anyone inserting a CVAD needs to take account of body position changes that may cause a tip to move. There are many tools and systems nurses can use to aid tip positioning, including taking body measurements, using body landmarks and electrocardiograms (ECGs). Tip position must be checked on a chest X-ray. There are several ways to determine tip postion and electromagnetic catheter tip guidance machines are being developed in the USA, which can record the position of a tip with greater accuracy. Nurses inserting CVADs at the bedside must appreciate the risks that incorrect or suboptimal tip position pose to the patient.