LAUSR

Introduction/Hypothesis: Central venous catheter (CVC) placement can result in CVC “malpositioning”, an unintended placement of the catheter tip, most commonly in a vessel other than the superior vena cava (SVC). Malpositioned CVCs have historically necessitated catheter manipulation/removal. This study aims to redefine catheter malposition by evaluating subsequent intervention(s) related to CVC malposition. Methods: This study used data from a retrospective chart review of CVC placement in a tertiary hospital setting from 1/2013 12/2014. Correct CVC placement was confirmed by post-insertion chest x-ray (CXR). Malposition was defined as radiologic interpretation of a CVC tip in a vein other than the SVC. Catheter reposition or manipulation was defined as documentation of a new procedure note or radiographic evidence of a new catheter with removal of the old catheter less than 24hrs after initial placement. Data points analyzed included CVC malposition frequency, catheter reposition rate, catheter duration, and incidence of complications such as catheter associated venous thrombosis. Results: The data set had a total of 3069 CVC insertions. The malposition rate of CVC placement is 9.3%. The percentage of CVCs radiographically reported as “malpositioned” that the bedside physicians removed or replaced is 31.9% (91 out of 285 malpositioned observations). “Malpositioned” catheters that were left in place by the clinical team (n = 194) had an average catheter duration of 8.3 days (95% CI 8.17-6.15) versus 7.2 days (95% CI 5.87-3.87) for catheters that were replaced or repositioned. The incidence of venous thrombosis in repositioned “malpositioned” catheters was 7.7% versus 5.1% for “malpositioned” catheters that were left in place. If the 194 “malpositioned” catheters that were not clinically removed are not considered to be truly malpositioned, the rate of malposition requiring catheter replacement/manipulation is now 3.0% (91 out of 3069 malpositions). Conclusions: Optimal positioning of the tip of a CVC is a controversial subject with differing opinions and conflicting clinical practices. In this study, both replaced and non-replaced venous “malpositioned” catheters had similar catheter duration days and had no evidence of increased complications, challenging the current definition and risks of venous CVC malposition.