![]() Repositioning rates were significantly higher in females (12/25) as compared with males (13/58) in right-sided IJV catheters ( P = 0.019, CI 95%), whereas no significant difference was observed in males and females with regard to left-sided IJV catheters.Īfter repositioning, chest radiograph was repeated to confirm the position of the tip and the catheter insertion depth was noted.ĬVC insertion is associated with many mechanical complications with an incidence varying from 6.2% to 11.8% in subclavian and internal jugular approaches. Repositioning was done in 13 of 58 (22.41%) patients in right-sided IJV catheters, whereas in 2 of 13 (15.38%) in left-sided IJV catheters in males, whereas repositioning was required in 12 of 25 (48%) in right-sided IJV catheters and in 2 of 11 (18.18%) in left-sided IJV catheters in females. Repositioning rate in right-sided IJV catheters (25/83) compared with left-sided ones (4/24) was not significant ( P = 0.19, CI 95%). Chi-square test performed showed that repositioning rate was higher in females which was statistically significant ( P = 0.05, CI 95%). Among 36 females, 25 (69.44%) had right IJV catheters, whereas 11 (30.55%) had left IJV catheters.Īfter observing the position of the catheter tip in post procedure chest radiograph, catheter repositioning was required in 15 of 71 males and 14 of 36 females. Total number of right IJV catheters was 83 (77.57%) and that of left IJV catheters was 24 (22.43%).Īmong the 71 male patients, 58 (81.69%) had right IJV catheters, whereas 13 (18.3%) had left IJV catheters. Of the 107 patients evaluated, there were 71 male and 36 female patients. The depth of insertion of the catheter after repositioning was noted and was confirmed by a repeat chest radiograph. Catheters were repositioned after checking the tip position in the chest radiograph. CVC tip position was judged as correct if the tip was positioned just above the level of carina for right IJV catheters and just below the level of carina for left IJV catheters. A post procedure portable chest radiograph was performed in all the cases in supine position, for assessing the position of the tip of the catheter. ![]() The catheters were inserted to a length of 13-14 cm in right-sided catheters and to a length of 14-15 cm in left-sided catheters. ![]() All catheters were placed by intensivists and trained doctors.Īll catheters (double/triple lumen Certofix B Braun) were placed blindly through the central approach using the Seldinger's technique. Patients with altered coagulation parameters, arrhythmias, pacemaker in situ, short neck, burn contractures of the neck and cervical spine injury were excluded from the study. CVCs placed through the right and left internal jugular veins (IJVs) were evaluated. The position of the CVC tip was considered correct in the chest radiograph if it was just above the carina in right-sided catheters and just below the carina in left-sided catheters.Īfter approval by the institutional ethics committee, 107 patients in the age group of 20-60 years were enrolled in this prospective observational study. The position of the tip of the catheter and the rate of repositioning was observed. In this study, we evaluated 107 patients in whom CVCs were placed as part of the management. Various methods such as anatomical landmarks, simple formulae, right atrial electrocardiography and echocardiography have been used to ensure correct placement of the CVC tip. It is also recommended that the catheter tip should lie in the long axis of the SVC, without acute abutment to the vein wall. The correct position of the tip of CVC is considered to be in the superior vena cava (SVC) above the level of pericardial reflection. Apart from thrombosis and infections, their use is associated with many mechanical complications such as cardiac tamponade, perforation, pneumothorax and life-threatening arrhythmias.įor proper monitoring of central venous pressure and to avoid some of the life-threatening mechanical complications it is mandatory that the tip of the catheter lies in the correct position. Central venous catheters (CVC) play a very important role in the management of critically ill patients in both ICUs and special wards.
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