Misplacement and Loop Formation of Central Venous Catheters

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Abstract
Exact placement is an essential prerequisite for long‐term use of a central venous catheter. Reported data show an extremely wide range of catheteral misplacements: from less than 1 % to more than 60%. Some approaches appear to be less advantageous than others, but the highest rates of misplacement occur in the cubital, external jugular and saphenous veins.A series is presented of 378 radiographically controlled central venous catheters analysed for aberrant placement and loop formation. The total occurrence of faulty positioning and coiling reached 5.3%, while the respective incidences were 30:/, for the external jugular vein, 5.7% for the internal jugular vein, 5.5% for the infraclavicular technique of subclavian venepuncture, 5.3% for the innominate vein and 1.4% for the supraclavicularapproach of subclavian venepuncture. The total frequency for pure loop formation was 2.9%.The authors discuss numerous reported data on catheter malpositioning, according to the specific techniques used, and compare them with their own results. The relatively low incideffce in the present series is possibly due to the high proportion of cases where the supraclavicular subclavian approach was used, the omission of the saphenousjfemoral andcubital techniques, and to pre‐determining the length of the inserted catheteral segments.

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