Malpositioning of Long-Staying Central Venous Catheters in the Pediatric Population: Incidence and Potential Complications. A Single-Center Retrospective Study and a Narrative Review of the Literature.

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Niki Kouna George Noutsos Christina Koufopoulou Dimitrios Panagopoulos Antonis Kattamis


Central Venous Catheters insertion is a very common procedure performed at the operation room and the Intensive Care Unit. In the paediatric population they are frequently used to administer fluids, blood products, resuscitation drugs, parenteral nutrition and chemotherapy. One of the reported complications, though a less commonly described one, is the inappropriate position of the tip of the CVC in a vessel other than the superior vena cava.

In this study, we initially present the anatomy of the superior vena cava system and that of the internal jugular vein, the optimal catheter tip position as well as the possible suboptimal catheter tip locations. Subsequently, paediatric chest X-rays of our hospital with catheter tip malpositioning are illustrated, after internal jugular vein catheterization. Following, we discuss possible mechanisms of central venous catheters malpositioning, signs and symptoms which could help us identify a wrong placement and also how to prevent as well as how to fix one. Finally, an interrelation between malpositioning, malfunction and the existence of infection or thrombosis is investigated.

Our study concluded that the right internal jugular vein should be the first choice in all cases of vessel implantation, mainly based on our statistical analysis results, which suggested that this vessel was associated with the least possibility of erroneous catheter placement. Another important clue of our study is based on the fact that the inappropriate positioning of a central venous catheter over the long term could be a significant predisposing factor of malfunction, along with infection and thrombosis.

Keywords: internal jugular vein, central venous catheter, malposition

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KOUNA, Niki et al. Malpositioning of Long-Staying Central Venous Catheters in the Pediatric Population: Incidence and Potential Complications. A Single-Center Retrospective Study and a Narrative Review of the Literature.. Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 29 may 2023. doi:
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1. Ganeshan A, Warakaulle DR, Uberoi R. Central venous access. Cardiovasc Intervent Radiol. 2007;30(1):26-33.
2. Roldan CJ, Paniagua L. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction. West J Emerg Med. 2015;16(5):658- 664.
3. Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007;33(6):1055-1059
4. Sanford TJ Jr. Internal jugular vein cannulation versus subclavian vein cannulation. An anesthesiologist's view: the right internal jugular vein. J Clin Monit. 1985;1(1):58-61.
5. Wang L, Liu ZS, Wang CA. Malposition of Central Venous Catheter: Presentation and Management. Chin Med J (Engl). 2016;129(2):227-234.
6. Bhatia P, Saied NN, Comunale ME. Management of an unusual complication during placement of a pulmonary artery catheter. Anesth Analg. 2004;99(3):669-671.
7. Ambesh SP, Pandey JC, Dubey PK. Internal jugular vein occlusion test for rapid diagnosis of misplaced subclavian vein catheter into the internal jugular vein. Anesthesiology. 2001;95(6):1377-1379.
8. Singh GP, Prabhakar H, Reddy BK. Malposition of internal jugular vein catheter into contralateral internal jugular vein: An uncommon position. Indian J Anaesth. 2012;56(2):205-207.
9. El-Kersh K, Cavallazzi R, Saad M, Guardiola J. Unusual Placement of a Central Venous Catheter: Left Pericardiophrenic Vein. West J Emerg Med. 2015;16(3):422-423.
10. Bankier AA, Mallek R, Wiesmayr MN, et al. Azygos arch cannulation by central venous catheters: radiographic detection of malposition and subsequent complications. J Thorac Imaging. 1997;12(1):64-69.
11. Calviño J, Bravo J, Martínez L, Millán B, Pulpeiro JR. Recognizing misplacement of a dialysis catheter in the azygos vein. Hemodial Int. 2013;17(3):455-457.
12. Sandroni, C., Pirronti, T., Tortora, F. et al. Unusual central venous catheter malposition into the left internal mammary vein: a case report. Intensive Care Med 2003;(29):2338–2339.
13. Wang L, Liu ZS, Wang CA. Malposition of Central Venous Catheter: Presentation and Management. Chin Med J (Engl). 2016;129(2):227-234.
14. Dzierzega M, Ossowska M, Chmiel D, Wieczorek A, Balwierz W. The malposition of central venous catheters in children. Pol J Radiol. 2014;(79):275-278.
15. Chaskar V, Karnik PP, Dave NM, Garasia M. Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study. Turk J Anaesthesiol Reanim. 2018;46(2):116-120.
16. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286(6):700-707
17. Tripathi M, Dubey PK, Ambesh SP. Direction of the J-tip of the guidewire, in seldinger technique, is a significant factor in misplacement of subclavian vein catheter: a randomized, controlled study. Anesth Analg. 2005;100(1):21-24.
18. Nazarian GK, Bjarnason H, Dietz CA Jr, Bernadas CA, Hunter DW. Changes in tunneled catheter tip position when a patient is upright. J Vasc Interv Radiol. 1997;8(3):437-441.
19. Davies M, Guest PJ. Developmental abnormalities of the great vessels of the thorax and their embryological basis. Br J Radiol. 2003;76(907):491-502.
20. Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist's perspective. Semin Dial. 2007;20(1):53-62.
21. Schummer W, Schummer C, Schelenz C, Schmidt P, Fröber R, Hüttemann E. Modified ECG guidance for optimal central venous catheter tip positioning. A transesophageal echocardiography-controlled study. Anaesthesist. 2005;54(10):983-990.
22. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-1133.
23. Gravenstein N, Blackshear RH. In vitro evaluation of relative perforating potential of central venous catheters: comparison of materials, selected models, number of lumens, and angles of incidence to simulated membrane. J Clin Monit. 1991;7(1):1-6.
24. Movafegh A, Saliminia A, Atef-Yekta R, Azimaraghi O. A Rare Central Venous Catheter Malposition in a 10-Year-Old Girl. Case Rep Anesthesiol. 2018;(2):658-640
25. Abood GJ, Davis KA, Esposito TJ, Luchette FA, Gamelli RL. Comparison of routine chest radiograph versus clinician judgment to determine adequate central line placement in critically ill patients. J Trauma. 2007;63(1):50-56.
26. Peres PW. Positioning central venous catheters--a prospective survey. Anaesth Intensive Care.1990;18(4):536-539.
27. Venugopal AN, Koshy RC, Koshy SM. Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature. J Anaesthesiol Clin Pharmacol. 2013;29(3):397-400.
28. Bertini P, Frediani M. Ultrasound guided supraclavicular central vein cannulation in adults: a technical report. J Vasc Access. 2013;14(1):89-93.
29. Rastogi S, Bhutada A, Sahni R, Berdon WE, Wung JT. Spontaneous correction of the malpositioned percutaneous central venous line in infants. Pediatr Radiol. 1998;28(9):694-696.
30. Boersma RS, Jie KS, Verbon A, van Pampus EC, Schouten HC. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Ann Oncol. 2008 ;19(3):433-42.
31. Arul GS, Lewis N, Bromley P, Bennett J. Ultrasound-guided percutaneous insertion of Hickman lines in children. Prospective study of 500 consecutive procedures. J Pediatr Surg. 2009;44(7):1371-1376.
32. Avanzini S, Guida E, Conte M, et al. Shifting from open surgical cut down to ultrasound-guided percutaneous central venous catheterization in children: learning curve and related complications. Pediatric Surgery International. 2010 Aug;26(8):819-824.