Misplaced central venous catheters: applied anatomy and practical management

Area of Science:

• Radiology
• Vascular Anatomy
• Interventional Procedures

Background:

• Central venous catheters (CVCs) are frequently placed annually.
• CVC misplacement is a common occurrence during insertion.

Purpose of the Study:

• To review normal and abnormal central venous anatomy relevant to CVC placement.
• To discuss identification and management of CVC misplacement and complications.

Main Methods:

• Review of anatomical variations (embryological and acquired).
• Discussion of imaging techniques for verifying CVC placement.
• Analysis of management strategies for misplaced CVCs.

Main Results:

• Normal and variant anatomy aids in identifying misplacement.
• Embryological variations (e.g., persistent left superior vena cava) can lead to abnormal CVC courses.
• Acquired abnormalities like stenosis or thrombosis pose challenges.
• Misplacement outside veins can have severe consequences.
• Imaging is key to determining safe removal strategies.

Conclusions:

• Understanding central venous anatomy is vital for preventing and managing CVC misplacement.
• Careful consideration and imaging are necessary before removing misplaced CVCs, especially near vital structures.
• 'If in doubt, don't take it out' is a useful short-term guideline for misplaced CVCs.