Migration Of Central Venous Catheter Research Articles

Central catheter tip migration in critically ill patients.

Chest X-ray (CXR) is routinely required for assessing Central Venous Catheter (CVC) tip position after insertion, but there is limited data as to the movement of the tip location during hospitalization. We aimed to assess the migration of Central Venous Catheter (CVC) position, as a significant movement of catheter tip location may challenge some of the daily practice after insertion. Retrospective, single-center study, conducted in the Intensive Care and Cardiovascular Intensive Care Units in Tel Aviv Sourasky Medical Center 'Ichilov', Israel, between January and June 2019. We identified 101 patients with a CVC in the Right Internal Jugular (RIJ) with at least two CXRs during hospitalization. For each patient, we measured the CVC tip position below the carina level in the first and all consecutive CXRs. The average initial tip position was 1.52 (±1.9) cm (mean±SD) below the carina. The maximal migration distance from the initial insertion position was 1.9 (±1) cm (mean±SD). During follow-up of 2 to 5 days, 92% of all subject's CVCs remained within the range of the Superior Vena Cava to the top of the right atrium, regardless of the initial positioning. CVC tip position can migrate significantly during a patient's early hospitalization period regardless of primary location, although for most patients it will remain within a wide range of the top of the right atrium and the middle of the Superior Vena Cava (SVC), if accepted as well-positioned.

Spontaneous Migration of Central Venous Catheter to Anterior Mediastinum

Central venous devices are routinely used in delivering chemotherapy and total parenteral nutrition. Spontaneous migration of central venous catheters is a very rare complication, but the etiology of this problem is not clear. We report here a case of migration of a port catheter to the anterior mediastinum in a patient with stage IVC nasopharyngeal cancer during chemotherapy. The patient presented with pulmonary manifestations in form of shortness of breath and chest tightness caused by left massive pleural effusion. The pleural effusion was resolved by thoracocentesis and the migrated catheter was retrieved surgically.

Migration of Central Venous Catheter into the Pleural Space: A Rare Fatal Complication Averted

Migration of Central Venous Catheter into the Pleural Space: A Rare Fatal Complication Averted

中心静脈カテーテルが左上肋間静脈に迷入し左胸腔内に穿孔した1例

中心静脈カテーテルが左上肋間静脈に迷入し左胸腔内に穿孔した1例

Migration of Central Venous Catheters in Neonates: A Radiographic Assessment.

Objective This study aims to determine the frequency that umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs) migrate into the cardiothymic silhouette after initial verification of correct placement. Study Design This is a single-center, retrospective study in neonates in whom a PICC or UVC was placed. The frequency of catheter tip migration into the cardiothymic silhouette requiring catheter manipulation was determined radiographically at 1 and 24 hours, respectively, after insertion. Results At 1 and 24 hours, 36 and 23% of UVCs (n = 41) migrated into the cardiothymic silhouette, respectively. At 1 and 24 hours, 23 and 11% of PICCs (n = 63) migrated into the cardiothymic silhouette, respectively. Migration was not associated with birth weight, weight at insertion, or postnatal age at insertion. Conclusion UVCs and PICCs frequently migrate into the cardiothymic silhouette increase the risk for development of a pericardial effusion. Serial radiographic assessment of catheter tip location is needed to assess catheter migration within the first 24 hours of line placement.

Intratumoral migration of central venous catheter in a patient with malignant bronchial carcinoid.

Intratumoral migration of central venous catheter in a patient with malignant bronchial carcinoid.

Reducing PICC migrations and improving patient outcomes

Inadvertent migration of central venous catheters can lead to several issues including delayed therapy and clinical morbidities such as thrombosis. Peripherally inserted central catheters (PICCs) are particularly at risk of movement. An innovative new device which allows anchorage of the catheter has proved very successful in the minimisation of catheter migration. The SecurAcath device incorporates a small blunt anchor which lies beneath the skin in order to secure the catheter in place and prevent inadvertent movement. An evaluation of 31 patients with a SecurAcath device in situ to secure a PICC found only one case of insignificant catheter migration. Some initial problems with infection and pain were encountered and interventions were put in place to minimise their incidence. SecurAcath removal proved to be the most significant challenge but this can be overcome with suitable guidance and training.

A complication of port-a-cath: disconnection and migration of central venous catheter to pulmonary artery. A case report.

A 50 year old woman, with breast cancer undergoing chemotherapy. Login to removal because of the disconnection between the catheter and the subcutaneous port, diagnosed in routine check. In this case the X-ray showed the disconnection between the catheter and the subcutaneous port. And the consequent migration of the catheter, through cardiac cavities, into the pulmonary artery. Embolized catheter was removed by interventional radiology, under local anesthesia and intravenous sedation.The retrieval of the fragment was performed successfully using a snare catheter passed through the right femoral vein.

Monitoring central venous pressure: proximal or distal lumen?

Alsafi et al. [1] recommend that central venous pressure (CVP) should be monitored via the proximal lumen of a central venous catheter to help detect catheter migration. We fully support this, but do not agree with their statement that ‘traditionally, the proximal port of the central venous catheter is used for CVP monitoring.’ In fact, most of the intensive care units (87%) in the UK use the distal lumen to monitor CVP, and only 5% use the proximal lumen [2]. Undetected central venous catheter migration can lead to subcutaneous administration of drugs resulting in significant morbidity [3] and even death [4]. Monitoring the CVP via the proximal port would appear to be a simple method to aid detection of catheter migration through loss of the normal CVP trace. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.

Accidental cut of peripherally inserted central venous catheter

Dear Editor, Peripheral central venous catheterization (PICVC) is a popular technique for maintenance of an intravenous line for longstanding duration, as it does not require specific skill and is devoid of serious complications such as pneumothorax, hemothorax, tearing of vessels, hematoma, etc. associated with other routes of central venous cannulation [1, 2], although cases of fracture and migration of distal fragment have been reported in literature from time to time [3, 4]. Accidental cut and migration of central venous catheter (CVC) during a haircut has been reported in the literature [5]. We came across a complication with PICVC. An 18 SWG (Medicent TM ) catheter was inserted through the basilic vein and fixed on the right forearm. On the fourth day during change of dressing this catheter was accidentally cut near to its hub as it was entangled in dressing and adhesive plaster (Fig. 1). Another PICVC could not be passed due to extensive phlebo-thrombosis of both the arms. Suddenly, the idea of insertion of an 18 SWG conventional intravenous cannula into the long end of the central catheter lying outside the vein was proposed by our colleague. The patient was shifted to minor OR and the cut end of the PICVC was cleaned with 5% Povidone-Iodine IP. Under strict aseptic conditions, we pushed an 18 SWG i.v. cannula along with metal stylet into the PICVC device, after removing the sheath of the introducer, till it fitted tightly. A knot with size 3-0 sterile silk thread was put around the insertion site. To our surprise, there was no fluid leak after removal of the metal stylet and connection to the i.v. fluid line. This simple and cost-effective idea saved us performing an open surgical venous cannulation or other technically difficult subclavian, jugular or femoral cannulation, which should only be used in specific cases as they have serious complications, as stated above. Figure 2 shows distal fragment of PICVC along with intravenous cannula after removal from the vein on the 15th day. However, it is recommended that this procedure should be done under

Transesophageal Echocardiography for Verification of the Position of the Electrocardiographically-Placed Central Venous Catheter

Compare changes in P-wave amplitude of the intra-atrial electrocardiogram (ECG) and its corresponding transesophageal echocardiography (TEE)-controlled position to verify the exact localization of a central venous catheter (CVC) tip. A prospective study. University, single-institutional setting. Two hundred patients undergoing elective cardiac surgery. CVC placement via the right internal jugular vein with ECG control using the guidewire technique and TEE control in 4 different phases: phase 1: CVC placement with normalized P wave and measurement of distance from the crista terminalis to the CVC tip; phase 2: TEE-controlled placement of the CVC tip; parallel to the superior vena cava (SVC) and measurements of P-wave amplitude; phase 3: influence of head positioning on CVC migration; and phase 4: evaluation of positioning of the CVC postoperatively using a chest x-ray. The CVC tip could only be visualized in 67 patients on TEE with a normalized P wave. In 198 patients with the CVC parallel to the SVC wall controlled by TEE (phase 2), an elevated P wave was observed. Different head movements led to no significant migration of the CVC (phase 3). On a postoperative chest-x-ray, the CVC position was correct in 87.6% (phase 4). The study suggests that the position of the CVC tip is located parallel to the SVC and 1.5 cm above the crista terminalis if the P wave starts to decrease during withdrawal of the catheter. The authors recommend that ECG control as per their study should be routinely used for placement of central venous catheters via the right internal jugular vein.

Migration of Central Venous Catheters: Implications for Initial Catheter Tip Positioning

To evaluate the change in position of chest wall central venous access catheters (CVACs) after placement. Complication rates associated with catheter tip position were reviewed. Fifty patients (36 women, 14 men) with chest wall CVACs placed in the angiography suite were studied. Catheter migration was calculated as the difference between the carina-catheter tip measurements on immediate supine and upright postprocedure (within 24 hours) chest radiographs. Catheter-related complication data were gathered via telephone interview and review of the medical records. Peripheral catheter migration occurred in 49 of 50 patients (average, 3.2 cm +/- 1.8); central catheter migration occurred in one of 50 patients (3.9 cm). Catheter type was the only significant factor that affected the amount of migration; side of insertion or the patient's gender were not significant. Catheter malfunction and symptomatic upper extremity venous thrombosis rates tended to be lower in patients with right atrial versus superior vena cava catheters (18% vs 34%), but differences were not significant (P = .202). Catheter migration after chest wall CVAC placement is a common event. The catheter tip should be initially positioned approximately 3-4 cm more centrally than the desired final position. Further study is necessary of catheter-related complication rates relative to the final position of the catheter tip.

Central Venous Catheter Migration to the Popliteal Artery During Total Cavopulmonary Shunt

Central venous catheter migration to the arterial system occurred due to the surgical procedure during total cavopulmonary shunt. The catheter seems to have crept into the portion of the vena cava that had been designated for clamping, because of the position for the surgery and the anatomic characteristics of the patient. The catheter migrated in the right popliteal artery and was removed immediately; however, it could enter the pulmonary arterial system and the other systemic arterial branches.

Aberrant central venous catheter complicating radical neck dissection

Abnormal migration of central venous catheters is especially common in the case of long lines inserted via the antecubital fossa. A case is described of internal jugular vein migration of a central venous catheter complicating an ipsilateral radical neck dissection.