ABSTRACT:
Anaesthesiologist and intensive care physicians are the best skilled people for placement of central venous catheter. Complications related to Central venous catheter placement have decreased by substantial number due to use of ultrasound guidance to place or insert the same. Sometimes central venous catheter tip can be placed in an undesired vessel which is totally unintended called as central venous catheter malposition. This undesired position is not the complication of central venous catheter insertion but not paying attention to same on post procedure X-ray chest can lead to significant mortality and morbidity. After encountering one such incidence and it’s amazing look on chest x-ray(Fig 1 and Fig 2), I decided to dig into literature and found some interesting explanations that why and how it happened? After reviewing number of articles, it was found that central venous catheter malposition is associated with anatomical variance which can be congenital or acquired, use of left side of venous system for central venous catheter insertion, bevel orientation while inserting needle to locate central vein and physique of the patient. The purpose of this review is to address reasons for this malposition and ways to identify, correct and avoid the same. Even though X-ray chest is the standard imaging modality to detect complications of central venous catheter insertion, any unusual signs and symptoms ofcent ral venous catheter malposition should prompt operator to use additional diagnostic tools even if X-ray chest is normal or inconclusive to rule out malposition.
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