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Central venous catheter tip migration due to tracheal extubation: a prospective randomized study
Manuel F Struck1, Theresa Jünemann2, Konrad Reinhart3
1Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. manuelstruck@web.de.
Journal of Clinical Monitoring and Computing
|July 30, 2016
Summary
Tracheal extubation after central venous catheterization (CVC) did not cause significant CVC tip malposition. However, CVC tips showed a trend toward proximal migration, particularly with left internal jugular vein approaches, warranting consideration for optimal placement.
Area of Science:
- Cardiology
- Anesthesiology
- Medical Devices
Background:
- Central venous catheterization (CVC) is common in mechanically ventilated patients.
- Potential CVC tip migration after extubation due to pressure changes is a concern.
Purpose of the Study:
- To investigate CVC tip migration after tracheal extubation in patients undergoing cardiac surgery.
- To assess the impact of breathing changes on CVC tip position.
Main Methods:
- Randomized trial of right vs. left internal jugular vein CVC placement.
- CVC tip position measured by ECG, transesophageal echocardiography, and CXR at multiple time points.
- Analysis of 60 patients undergoing cardiac surgery under mechanical ventilation.
Main Results:
- CVC tips remained in the superior vena cava, below the pericardiac reflection.
- ECG showed significant proximal migration from placement to extubation (P < 0.001).
- Chest radiography revealed no significant migration between postoperative assessment and extubation (P = 0.196).
Conclusions:
- Tracheal extubation is not associated with significant postoperative CVC tip malposition.
- A trend toward proximal CVC tip migration exists, especially with left-sided approaches.
- Awareness of this migration trend is crucial for safe CVC placement.
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