Management of malpositioned central venous catheters

Through research and clinical trials at The University of Texas M. D. Anderson Cancer Center, central venous catheters have gained wide acceptance and are being used for an increasing number of applications. More than 30,000 patients have had a CVC placed since the inception of the M. D. Anderson program in 1976. The soft and less thrombogenic silicone elastomer catheter is the most commonly used catheter in the institution. This study found that most commonly observed malpositions are related to the puncture site and technique, venous anatomy, and catheter characteristics. The study also indicated that the majority of malpositioned central venous catheters need not be removed but can be safely repositioned using rapid flushing, patient positioning, partial withdrawal, or simple or deflective guidewire techniques. Early recognition and management of malpositioned central venous catheters not only guard against serious complications but also allow proper catheter function and prevent delay of intravenous therapy.