Research Articles | Challenge Journal of Perioperative Medicine

Radiological evaluation of central venous catheter tip malposition

Meltem Ceylan Delice, Nilgun Kavrut Ozturk


DOI: https://doi.org/10.20528/cjpm.2025.02.004
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Abstract


Background: Malposition of central venous catheters is a potentially severe but often preventable complication. This study aimed to assess the radiological distribution of central venous catheter tip positions and to discuss malposition mechanisms based on anatomical and radiographic literature.

Methods: A retrospective analysis of 374 patients who underwent intraoperative central venous catheter insertion between January 2022 and December 2023 was conducted. Radiographs were evaluated using a carina-based classification system: Zones A–C (normal) and Zone D (malposition). Data were analyzed retrospectively.

Results: The right internal jugular vein was the most commonly preferred access site, used in 80.0% of cases. Zone A: 52.3%, Zone B: 18.5%, Zone C: 17.8%, Zone D (malposition): 11.4%. There was no statistically significant association between catheter size and malposition (p>0.05).

Conclusion: Utilizing the carina as a reference point during post-procedural imaging is essential for accurate catheter tip localization. Adjunctive modalities—including intracavitary ECG, ultrasound, and radiography—contribute to complication reduction and procedural safety.


Keywords


central venous catheterization; catheter complication; malposition; radiological imaging

References


Gibson F, Bodenham A. Misplaced central venous catheters: Applied anatomy and practical management. Br J Anaesth. 2013;110(3):333–346.

McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123–1133.

Raptis DA, Neal K, Bhalla S. Imaging approach to misplaced central venous catheters. Radiol Clin North Am. 2020;58(1):105–117.

Yilmazlar T, Bilgin H, Ozturk E. Right atrial catheter misplacement: When ultrasound is not enough. J Crit Care. 2019;52:221–223.

Pikwer A, Acosta S, Kölbel T, Malina M, Sonesson B, Akeson J. Management of inadvertent arterial catheterisation associated with central venous access procedures. Eur J Vasc Endovasc Surg. 2009;38(6):707–714.

Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci. 2015;5(3):170–178.

Guilbert MC, Elkouri S, Bracco D, et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg. 2008;48(4):918–925.

Roldan CJ, Paniagua L. Central venous catheter intravascular malpositioning: Causes, prevention, diagnosis, and correction. West J Emerg Med. 2015;16(5):658–664.

Wang L, Liu ZS, Wang CA. Malposition of central venous catheter: Presentation and management. Chin Med J (Engl). 2016;129(2):227–234.

Nifong TP, McDevitt TJ. The efficacy of ultrasound in preventing catheter misplacement. Chest. 2011; 139(3):535‒540.

Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. ECG-guided tip placement of central venous catheters: A meta-analysis. Anesth Analg. 2017; 124(2):538‒546.

Demirok A, Nagelkerke SCJ, Gouw SC, de Koning BAE, van Ommen CH, Duister R, et al. Prophylactic anticoagulation in children receiving home parenteral nutrition: An international prospective multicenter study. Clin Nutr. 2025;46:88–95.


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