Late migration of subclavian venous catheter after initial correct placement

Abstract

due to increased intrathoracic pressure (positive pressure ventilation and PEEP) and increased intraabdominal pressure (hemangioma of liver), may have led to the malpositioning of the catheter into the contralateral IJV. It is possible that intravascular pressure changes caused by intermittent positive pressure ventilation (IPPV), congestive heart failure, strain-

Migration of subclavian venous catheter tip: Patient positioning in ICU makes a difference

“…[1] There are various factors held responsible for the spontaneous migration of catheter tip such as, “jet effect” of drug injection, increased intrathoracic, intra-abdominal pressures, and mechanical ventilation. [12] The CVC catheter tip placement in various venous tributary systems and structures such as left subclavian vein, left internal mammary vein, azygos vein, hemiazygos vein, lateral thoracic vein, inferior thyroid vein, left superior intercostal vein, thymic vein, pleural cavity, and the jugular foramen is known. [3] CVC malpositioning into left subclavian through right subclavian is also been described in literature.…”

“…A late migration of CVC tip from its initial position has been proposed to be with a possible explanation of more medial placement of catheters into subclavian vein. [1] This was related to mechanical compression forces in the cervico-axillary area between clavicle, subclavius muscle, costocoracoid ligament anteriorly and first rib, and anterior scalene ligament posteriorly. [2] Our CVC catheter placement is more lateral into the subclavian vein as recommended by de Graaff et al .…”

“…The migrated CVC catheter should be removed and new catheter should be placed, if continuous central venous pressure monitoring is required. [1]…”