Restricted accessCase reportFirst published online 2023-11
Time to abandon chest X-rays in favor of intracavitary ECG or echocardiography for central venous access tip location: A case of a malpositioned CICC into the internal mammary vein
Central vascular access devices (CVADs) correct tip location is of paramount importance to avoid malposition related complications. Despite recent guidelines recommend avoiding postprocedure radiograph in favor of alternative tip location technology, chest X-rays are still widely used in clinical practice as a CVADs tip location method. We present a clinical case of a central inserted central catheter (CICC) malposition in the right internal mammary vein, erroneously interpreted by chest X-rays as correctly placed, in a critically ill patient.
KimOHKimWSKimMJ, et al. US in the diagnosis of pediatric chest diseases. Radiographics2000; 20(3): 653–671.
4.
FisherKLLeungAN. Radiographic appearance of central venous catheters. Am J Roentgenol1996; 166(2): 329–337.
5.
GrayPSullivanGOstryzniukP, et al. Value of postprocedural chest radiographs in the adult intensive care unit. Crit Care Med1992; 20(11): 1513–1518.
6.
RaptisDANealKBhallaS. Imaging approach to misplaced central venous catheters. Radiol Clin North Am2020; 58(1): 105–117.
7.
VeselyTM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol2003; 14(5): 527–534.
8.
PittirutiMLa GrecaAScoppettuoloG. The electrocardiographic method for positioning the tip of central venous catheters. J Vasc Access2011; 12(4): 280–291.
9.
CalabreseMMontiniLArlottaG, et al. A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients. J Vasc Access2019; 20(5): 516–523.
10.
GaoYLiuYZhangH. The safety and accuracy of ECG-guided PICC tip position verification applied in patients with atrial fibrillation. Ther Clin Risk Manag2018; 14: 1075–1081.
11.
IacoboneEEliseiDGattariD, et al. Transthoracic echocardiography as bedside technique to verify tip location of central venous catheters in patients with atrial arrhythmia. J Vasc Access2020; 21: 861–867.
12.
PittirutiMPelagattiFPinelliF. Intracavitary electrocardiography for tip location during central venous catheterization: a narrative review of 70 years of clinical studies. J Vasc Access2021; 22(5): 778–785.
