Malposition Of Central Venous Catheter Research Articles

Virtual Chest Radiographs Developed From Computed Tomography Images for Differentiating Central Venous Versus Misplaced Arterial Lines and for Training Radiologists

Objective Radiographic findings to identify central venous catheter misplacement in the arteries, which can cause lethal complications, have not been fully evaluated, and its training is difficult because it is rare. The purpose of this study is to clarify radiographic findings for differentiating central venous and misplaced arterial lines using virtual chest radiographs and elucidate their usefulness in training radiologists. Methods This retrospective study included 150 patients (mean age, 67 [SD, ±12] years; 97 men) who underwent colon cancer surgery between January 2018 and December 2020. Virtual chest radiographs, including 6 oblique projections at 5° intervals, were developed from the computed tomography images using ray-sum reconstruction. Virtual venous and arterial lines were drawn from the right neck to the superior vena cava and aorta, respectively. Diagnostic abilities, including area under the curve (AUC) analysis of the 7 proposed radiographic findings for differentiating these lines in 100 patients, were evaluated. The diagnostic performance, including AUC analysis by 5 radiologists in the other 50 patients, was compared before and after disclosing these results to the radiologists. Results The findings of crossing over the right paratracheal stripe and running along the paracaval line showed the highest AUC for indicating arterial and venous lines in the frontal, right anterior oblique 15°, and left anterior oblique 15° projections (AUC = 0.992, 0.991, and 0.979, and 1.000, 0.994, and 0.998, respectively). The diagnostic performance of the radiologists improved after informing them of these results (AUC, 0.982–0.999 to 0.993–1.000 [P = 0.145–1.000] for the frontal projections and 0.932–0.970 to 0.967–0.995 [P = 0.075–0.150] for the oblique projections). Conclusions Virtual chest radiographs created from computed tomography images were useful for clarifying radiographic findings for differentiating central venous and misplaced arterial lines and for training radiologists.

Optimizing Catheter Verification

Purpose Accurate detection of central venous catheter (CVC) misplacement is crucial for patient safety and effective treatment. Existing artificial intelligence (AI) often grapple with the limitations of label inaccuracies and output interpretations that lack clinician-friendly comprehensibility. This study aims to introduce an approach that employs segmentation of support material and anatomy to enhance the precision and comprehensibility of CVC misplacement detection. Materials and Methods The study utilized 2 datasets: the publicly accessible RANZCR CLiP dataset and a bespoke in-house dataset of 1006 annotated supine chest x-rays. Three deep learning models were trained: a classification network, a segmentation network, and a combination of both. These models were evaluated using receiver operating characteristic analysis, area under the curve, DICE similarity coefficient, and Hausdorff distance. Results The combined model demonstrated superior performance with an area under the curve of 0.99 for correctly positioned CVCs and 0.95 for misplacements. The model maintained high efficacy even with reduced training data from the local dataset. Sensitivity and specificity rates were high, and the model effectively managed the segmentation and classification tasks, even in images with multiple CVCs and other support materials. Conclusions This study illustrates the potential of AI-based models in accurately and reliably determining CVC placement in chest x-rays. The proposed method shows high accuracy and offers improved interpretability, important for clinical decision-making. The findings also highlight the importance of dataset quality and diversity in training AI models for medical image analysis.

A Needle's Misdirection: Unravelling Vascular Injuries in Malpositioned Central Venous Catheters and Safe Removal Approaches

Central venous catheters (CVC) are commonly inserted to obtain vascular access. Complications such as vascular injuries arising from malpositioned CVC may occur, and safe surgical removal is required to prevent further complications. We retrospectively reviewed all patients treated in the cardiothoracic surgery department at our institution in the past 10 years for intrathoracic vascular injuries in malpositioned CVC without the need for concurrent cardiac or thoracic surgical procedures. Among the 21 patients in our series, 2 patients (10%) had a single arterial injury, 16 patients (76%) had venous injuries only, and 3 patients (14%) had both arterial and venous injuries. 16 patients (76%) underwent surgery to remove the malpositioned CVC; majority of them underwent sternotomy (n=12, 57%) and 7 of them had repair of blood vessels, and 4 patients (19%) underwent video assisted thoracoscopic surgery (VATS). 2 out of the 5 patients who had their CVC directly removed followed by external compression required emergency sternotomy due to pericardial effusion. In patients with artery or mediastinal vessel injuries, a sternotomy approach was preferred, whereas VATS was chosen when subclavian vessels or brachiocephalic vein injuries were noted. Endovascular procedures are alternatives for high surgical risk patients, but these advanced procedures are currency limited due to high expertise and facilities requirements.

Malposition of Central Venous Pressure Catheter as a Rare Cause of Tricuspid Valve Prosthesis Malfunction: A Case Report

Prosthetic valve malfunction is a hazardous clinical entity that needs early diagnosis and management. Hereby, we present a case of tricuspid valve (TV) malfunction due to interaction of central venous pressure (CVP) catheter with TV leaflets. Our case was a 38-year-old male who referred to our center with the diagnosis of TV malfunction. Confirming the diagnosis of TV malfunction, intravenous Heparin was initiated. Anticoagulation therapy was discontinued early due to the development of significant headache in the setting of subarachnoid hemorrhage. Due to contraindication of anticoagulation therapy, he underwent redo TV. On the 4th post-operative day, echocardiography examination illustrated significant increase in gradients of TV prosthesis. At this time, fluoroscopy depicted interaction of CVP catheter with TV leaflets due to its cardiac advancement resulted in fixed TV leaflets in semi-open position. By extraction of CVP catheter the TV gradients improved immediately. Malposition of CVP catheter or large CVP catheter could be considered as one of the rare causes of TV malfunction. Repositioning of CVP catheter brings dramatic improvement in this case.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominal radiographs because it overlaps with the inferior vena cava on anteroposterior radiographs. Intensive observation by medical providers may be a cue for diagnosis. However, knowledge of catheter misplacement of the right ascending lumbar vein is also necessary, because misplacement cannot be suspected without that awareness.

Malposition of Central Venous Catheter into Coronary Sinus throughout the Persistent Left Superior Vena Cava and Other Complications Related to Catheterization.

This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients.

On the way to the azygos vein: a road of return rather than ruined

BackgroundThe malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter.Case presentationA 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications.ConclusionsCVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.

A rare case of pulmonary complication after laparoscopic sleeve gastrectomy in an obese patient, associated with central venous catheter malposition: a case report

Introduction: Surgical intervention for morbid obesity possesses a first-line treatment and it is widespread worldwide. Obese patients have a high chance of postoperative complications and mortality is significantly raised with higher BMI levels. In addition to this, the altered anatomy of obese patients characterizes the central venous catheter insertion as a difficult procedure. Case presentation: In our case report we present a 52-year-old woman who admitted in our surgical department in order to be treated surgically for morbid obesity. All of her preoperative evaluation tests were absolutely normal. The patient was treated with laparoscopic sleeve gastrectomy. On postoperative day 2 the patient presented with acute dyspnea and low oxygen saturation. Diagnosis: After evaluation with computed tomography of the thorax an excessive right pleural effusion was diagnosed and the patient was treated with thoracic tube insertion. There was a fully recovery and the patient discharged after a couple of days. Conclusion: High mortality and morbidity after laparoscopic sleeve gastrectomy is a crucial parameter for postoperative complications in obese patients. High suspicion and wide spectrum of differential diagnosis results in early prevention and solution of the problem.

Using central venous pressure waveform to confirm the placement of an internal jugular central venous catheter in the intensive care unit

BackgroundA mobile chest X-ray is traditionally performed to confirm the position of an internal jugular central venous catheter (CVC) after placement in the intensive care unit (ICU). Using chest radiography to confirm CVC position often results in delays in authorising the use of the CVC, requires the deployment of additional human resources, and is costly. ObjectiveThis study aimed to determine the feasibility and accuracy of using the central venous pressure (CVP) waveform to confirm the placement of internal jugular CVCs. MethodsThis retrospective study was conducted in a single quaternary ICU over a 6-month period. We included adult patients who had internal jugular CVC inserted and CVP transduced as part of their routine care in the ICU. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CVP waveform analysis in confirming the position of internal jugular CVC relative to chest radiography were calculated. ResultsA total of 241 internal jugular CVCs were inserted (in 219 patients, 35.6% female), and the CVP waveform was assessed. In 231 cases, this suggested adequate placement in a central vein, which corresponded with a correct position on subsequent chest X-ray. On six occasions, the CVP waveforms were interpreted as suboptimal; however, on chest X-rays, the CVCs were noted to be in a suitable position (sensitivity: 97.5%). Four suboptimal CVP waveforms were obtained, and they correctly identified CVC malposition on subsequent chest X-ray (specificity: 100%). The average time from CVC insertion to radiological completion was 118 minutes. ConclusionCVP waveform analysis provides a feasible and reliable method for confirming adequate internal jugular CVC position. The use of chest radiography can be limited to cases where suboptimal CVP waveforms are obtained.

Multi-task learning framework to predict the status of central venous catheter based on radiographs

Hospital patients can have catheters and lines inserted during the course of their admission to give medicines for the treatment of medical issues, especially the central venous catheter (CVC). However, malposition of CVC will lead to many complications, even death. Clinicians always detect the status of the catheter to avoid the above issues via X-ray images. To reduce the workload of clinicians and improve the efficiency of CVC status detection, a multi-task learning framework for catheter status classification based on the convolutional neural network (CNN) is proposed. The proposed framework contains three significant components which are modified HRNet, multi-task supervision including segmentation supervision and heatmap regression supervision as well as classification branch. The modified HRNet maintaining high-resolution features from the start to the end can ensure to generation of high-quality assisted information for classification. The multi-task supervision can assist in alleviating the presence of other line-like structures such as other tubes and anatomical structures shown in the X-ray image. Furthermore, during the inference, this module is also considered as an interpretation interface to show where the framework pays attention to. Eventually, the classification branch is proposed to predict the class of the status of the catheter. A public CVC dataset is utilized to evaluate the performance of the proposed method, which gains 0.823 AUC (Area under the ROC curve) and 82.6% accuracy in the test dataset. Compared with two state-of-the-art methods (ATCM method and EDMC method), the proposed method can perform best.

Catheter Misplacement Following Subclavian Vein Catheterization Under Ultrasound Guidance: An Infrequent and Unusual Malposition

The most common malposition seen during subclavian vein cannulation is to the ipsilateral internal jugular vein. We report a case of unusual malposition of a subclavian central venous catheter, where it was found to be forming a “figure of U” in the ipsilateral subclavian vein. Although the catheterization was done under ultrasound guidance, we could not visualize the course of the guidewire due to a poor ultrasound window. This report highlights the fact that although ultrasound can facilitate identification of the vessels and prevent inadvertent arterial puncture, it seldom helps in the positioning of the guidewire tip and prevention of catheter malposition.

High-resolution feature based central venous catheter tip detection network in X-ray images.

Hospital patients can have catheters and lines inserted during the course of their admission to give medicines for the treatment of medical issues, especially the central venous catheter (CVC). However, malposition of CVC will lead to many complications, even death. Clinicians always detect the malposition based on position detection of CVC tip via X-ray images. To reduce the workload of the clinicians and the percentage of malposition occurrence, we propose an automatic catheter tip detection framework based on a convolutional neural network (CNN). The proposed framework contains three essential components which are modified HRNet, segmentation supervision module, and deconvolution module. The modified HRNet can retain high-resolution features from start to end, ensuring the maintenance of precise information from the X-ray images. The segmentation supervision module can alleviate the presence of other line-like structures such as the skeleton as well as other tubes and catheters used for treatment. In addition, the deconvolution module can further increase the feature resolution on the top of the highest-resolution feature maps in the modified HRNet to get a higher-resolution heatmap of the catheter tip. A public CVC Dataset is utilized to evaluate the performance of the proposed framework. The results show that the proposed algorithm offering a mean Pixel Error of 4.11 outperforms three comparative methods (Ma's method, SRPE method, and LCM method). It is demonstrated to be a promising solution to precisely detect the tip position of the catheter in X-ray images.

Comparison between ultrasound and chest X-ray to confirm central venous catheter tip position.

Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively. This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a 'bubble test' to detect malposition and pneumothorax. Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the 'bubble test' and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR. Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3-6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18-56 min) (p < 0.0001). This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition. Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.

A Rare Malposition of a Left Internal Jugular Central Venous Catheter into the Left Internal Mammary Vein.

We describe a case of left internal jugular central venous access with rare malpositioning into the internal mammary vein. Despite various confirmatory measures at the time of placement including ultrasonography of the internal jugular vein, as well as blood gas analysis consistent with venous blood by oxygen saturation and good venous flow in all three ports of the catheter, subsequent imaging confirmed misplacement into the internal mammary vein. Central venous access is a frequently used procedure by emergency physicians for a variety of indications. Emergency physicians must be facile with both the technical process of central venous catheter placement, as well as possible pitfalls and complications of the procedure. Common complications, such as bleeding, pneumothorax, arterial injury, infection, and hematomas, are usually well known; less frequently encountered is malposition of the catheter despite seemingly appropriate placement.

Additionally using transthoracic echocardiography during ultrasound-guided jugular central venous catheter placement and the odds of catheter misplacement in children: A before-and-after study.

Central venous catheter (CVC) misplacement is a major complication.1 To avoid CVC misplacement, real-time ultrasound (US) guidance is recommended for CVC placement in children.2, 3 Transthoracic echocardiography (TTE) can be additionally used to confirm correct CVC tip position.4, 5 Whether additionally using TTE during US-guided jugular CVC placement reduces the incidence of catheter misplacement remains scarcely described. We thus sought to test the hypothesis that additionally using TTE during US-guided jugular CVC placement reduces the odds of CVC misplacement in children. After approval by the ethics committee with waiver of informed consent, we performed a retrospective before-and-after study in children aged 0–6 years who received a jugular CVC during anesthetic induction for congenital heart disease surgery at the University Medical Center Hamburg-Eppendorf (Hamburg, Germany) between March 2015 and April 2020. In our institution, jugular CVCs in children having cardiac surgery are routinely placed using real-time US guidance since 2013. In October 2017, routine use of additional TTE during US-guided jugular CVC placement was implemented. In the 31-month “before period” (March 2015 to September 2017), anesthesiologists did not use TTE but chose the CVC insertion depth considering patient height (no-TTE-group). In the 31-month “after period” (October 2017 to April 2020), additional TTE (subcostal long-axis view) was routinely used during US-guided jugular CVC placement to confirm the correct position of the guidewire and the CVC tip (rapid saline flush test) (TTE-group) (Figure S1). During both study periods, chest x-ray was used to confirm correct CVC tip position after surgery. We categorized CVCs as misplaced when the CVC tip ended above the level of the superior vena cava in a noncentral vein or deep in the right atrium (Figure S2). We investigated the associations between CVC misplacement and TTE use by logistic regression for all patients including age as covariate—and separately for patients aged <1 year and 1–6 years. We report the odds ratios (OR) with 95% confidence intervals. We included 373 patients (156 no-TTE-group and 217 TTE-group) (Table S1). CVC misplacement occurred in 15/156 no-TTE-group patients (9.6%) and in 5/217 TTE-group patients (2.3%). The odds for CVC misplacement were 371% lower when TTE was used compared to when it was not used (p = .004, OR = 0.21 [0.067–0.57]) (Figure 1). Of all 373 patients, 229 (61%) were younger than 1 year. In these patients, CVC misplacement occurred in 8/76 no-TTE-group patients (11%) and in 4/153 TTE-group patients (2.6%). The odds for CVC misplacement were 319% lower when TTE was used (p = .023, OR = 0.24 [0.062–0.79]). Of all 373 patients, 144 (39%) were between 1 and 6 years old. In these patients, CVC misplacement occurred in 7/80 no-TTE-group patients (8.8%) and in 1/64 TTE-group patients (1.6%). The odds for CVC misplacement were 480% lower when TTE was used (p = .107, OR = 0.17 [0.0090–1.0]). In our study, additionally using TTE during US-guided jugular CVC placement in children reduced the odds for CVC misplacement by more than 300%—which obviously is clinically meaningful. In only about 1% of children, the subcostal long-axis view could not be obtained—and TTE could thus not be used to confirm the CVC tip position. In general, children provide an excellent acoustic window for TTE examination of the right atrium and the superior vena cava. Nevertheless, TTE requires technical skills and operator experience. Our results need to be interpreted in light of the inherent limitations of retrospective before-and-after studies. Additionally, we only included children with congenital heart disease, whose anatomy may differ from healthy children. However, as we excluded patients with irregular venous conformations, we assume that our findings can be transferred to pediatric patients in general. Additionally using TTE during US-guided jugular CVC placement reduces the odds of CVC misplacement in children aged 0–6 years. Clinicians should consider additionally using TTE during US-guided jugular CVC placement to increase patient safety. This work was supported solely from institutional and/or department sources. There are no conflicts of interest to declare. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

MALPOSITION OF RIGHT INTERNAL JUGULAR VEIN CATHETER IN RIGHT AXILLARY VEIN: A RARE CASE DIAGNOSED BY BEDSIDE ULTRASOUND

MALPOSITION OF RIGHT INTERNAL JUGULAR VEIN CATHETER IN RIGHT AXILLARY VEIN: A RARE CASE DIAGNOSED BY BEDSIDE ULTRASOUND

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION DIAGNOSED AFTER CENTRAL VENOUS CATHETER PLACEMENT

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION DIAGNOSED AFTER CENTRAL VENOUS CATHETER PLACEMENT

Central Venous Catheter Malposition into the Left Internal Mammary Vein in Patient with Coagulation Disorder and Safe Removal: A Case Report

A 61-year-old male patient with underlying diseases of hypertension and alcoholic liver cirrhosis was hospitalized for liver transplantation due to advanced liver cirrhosis. In preparation for liver transplant surgery, a multi-lumen access catheter and Swan-ganz catheter are inserted into the right internal jugular vein. And another central venous catheter is inserted into the subclavian vein for central venous pressure measurement and drug administration. There was no abnormal resistance of the guide wire or catheter that the operator could feel during the insertion process, and there was no abnormality in the function of the catheter. But the postoperative chest image showed that the left subclavian central vein catheter was malpositioned. Through venography at the angiography room, it was confirmed that the central venous catheter was inserted into the left internal mammary vein. Since the patient with coagulation disorder, special attention was required to remove the catheter. In addition, due to the location of the internal mammary vein, it was expected that it would be difficult to compress for hemostasis after removal of the catheter. Therefore, it was necessary to check the patient's coagulation test to determine the appropriate time of the catheter removal and cooperation of the radiologist.

Vascular anomaly diagnosis by central venous catheter misplacement: a case report

BackgroundCongenital heart diseases rarely have a primary manifestation in adulthood. They are a rare cause of pulmonary hypertension in adults.Case presentationA 70-year-old woman of Eurasian descent underwent emergency surgery for bowel ischemia. Her history of mild pulmonary hypertension likely correlates with a peculiar diagnosis of an anatomic anomaly on the postoperative x-ray and computed tomography scan. The central venous catheter was misplaced. Initial management consisted of removal of the catheter. The diagnosis, partial anomalous pulmonary venous return, may pose a clinical therapeutic dilemma.ConclusionsPartial anomalous pulmonary venous return is a potentially treatable cause of pulmonary hypertension. With the current trend toward more medical imaging, we expect this diagnosis to be made more often in the future.

Echocardiographic Determination of Percutaneous Central Venous Catheters in the Superior Vena Cava: A Prospective Cohort Study.

Malposition of percutaneous central venous catheters (PCVCs) in the superior vena cava (SVC) is common. We previously showed that real-time sonography was safer and faster than radiography in identifying PCVC tip location in the inferior vena cava (IVC). However, in preterm infants, determining PCVC tip location in the SVC is complicated by endotracheal or nasogastric tubes in situ and emphysematous lung conditions. We aimed to find an appropriate sonographic view by which to assess PCVC tip location in the SVC compared to the sonographic examination of PCVC in the IVC. Neonates (n = 50) with PCVCs in the SVC were enrolled and their data (gestational age, gender, birth weight, body weight at intervention, repositioning rate, and duration of tip assessment) were compared with retrospective data of 50 neonates with PCVCs in the IVC. The mean gestational age in the groups of IVC and SVC was 31.43 weeks and 32.16 weeks, respectively. The mean birth weight in the groups of IVC and SVC was 1642.18 g and 1792.00 g, respectively. Placement of an S12-4 ultrasound sector transducer to obtain clear parasternal views of the aorta allows visualization of PCVC tips in the SVC and near the cavoatrial junction. PCVC repositioning rates were not significantly different between the two groups (p = 0.092). Sonography examinations in the SVC had a longer duration than those in the IVC (p < 0.001). Sonography provides an accurate method for determining PCVC tip location in the SVC.