Abstract:
Central venous catheter (CVC) placement is a common procedure used in both inpatient and outpatient settings. Incorrect CVC insertion can result in many complications, including arterial injury, hemorrhage, pneumothorax, pericardial effusion, or thrombosis. Therefore, confirming appropriate catheter positioning after placement at imaging is essential for patient safety. Radiologists play a critical role in ascertaining correct catheter placement and alerting clinicians to improperly placed lines. Because of its speed and accessibility in patients who are immobile, chest radiography is the preferred initial imaging modality in assessing catheter tip position.
The most common target for CVCs is the lower third of the superior vena cava (SVC), superior cavoatrial junction, or right atrium. The SVC is a right-sided structure. Left-sided internal jugular or subclavian vein–approach catheters should cross the midline just below the sternoclavicular joint. If they do not, suspicion should be raised for malpositioning. A left-sided catheter that does not cross to the right mediastinum may terminate outside the vessel lumen of the brachiocephalic vein or in another venous branch such as the internal mammary vein, as well as arterial or nonvascular locations (Fig 1). Similarly, right internal jugular or subclavian vein–approach catheters that cross to the left mediastinum should raise suspicion for potential arterial placement. Subclavian vein–approach catheters that take a high course much superior to the first rib may be in the subclavian artery.
Reference:Jhala K, Tang A, Hammer MM. Five-Step Guide to Central Venous Catheter Placement with 3D Anatomic References. Radiographics. 2021 Sep-Oct;41(5):E149-E150. doi: 10.1148/rg.2021210027. PMID: 34469218.