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Appraisal of the dislocation of central venous catheter tips using subclavian and arm veins
Insights
Central venous catheterization can cause heart perforation. Studies show arm vein insertion leads to significant catheter tip displacement, while subclavian routes offer greater stability, reducing cardiac risks.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Anatomy
Background:
- Central venous catheterization is essential but carries risks.
- Cardiac perforation is a severe complication of central venous catheterization.
- Catheter migration is a known issue, potentially leading to complications.
Purpose of the Study:
- To investigate catheter tip displacement during arm and shoulder movement.
- To compare the stability of peripherally and infraclavicularly inserted central venous catheters.
- To determine optimal catheter tip placement and insertion routes to minimize cardiac perforation risk.
Main Methods:
- Literature review of central venous catheterization complications.
- Postmortem examination of three patients with central venous catheters.
- Simulated arm and shoulder movements to assess catheter displacement.
Main Results:
- Catheter tips inserted via the basilic vein showed up to 8 cm displacement.
- Infraclavicular inserted catheter tips exhibited minimal to no displacement with arm movement.
- Extreme shoulder movements caused up to 2 cm displacement; adduction/flexion of the elbow caused advancement.
Conclusions:
- The subclavian route is recommended for central venous catheters over arm vein insertion.
- Subclavian catheter insertion offers superior stability, minimizing the risk of cardiac perforation.
- Optimal catheter tip placement is in the upper right atrium.
Abstract:
The most dramatic of the complications resulting from central venous catheterization is perforation of the heart. We studied the complications reported in the literature and undertook an original investigation of the dislocations of peripherally and infraclavicularly inserted catheters while moving the arm and shoulder in patients during autopsy. In a postmortem examination of three patients it was found that the greatest displacement, up to eight centimetres, of the tips of the catheters occurred when they were inserted through the basilic vein. The tips of infraclavicular inserted catheters did not move at all during movements of the arm. Only by extreme movements of the shoulder we were able to show a maximal displacement of two centimetres. Advancement of the catheter tip occurred during adduction and flexion of the elbow joint and not during abduction. Our experimental evidence suggests that the best site for a catheter tip is the upper part of the right atrium. We therefore recommend the subclavian route for in-dwelling central venous catheters rather than insertion through an arm vein, as this minimizes the risk of cardiac perforation due to its great stability.