Maneuvers to Facilitate Central Venous Catheter Advancement in the Clavicular Region

Abstract

BACKGROUNDThe central venous catheter (CVC) is a vascular access device, inserted by central or peripheral venipuncture, such as the peripherally inserted central catheter, that is frequently used to infuse intravenous solutions and electrolytes, parenteral nutrition, and medications. 1 Difficulty when advancing this kind of catheter can complicate tip positioning during infusion 2 in the right hemiclavicular region 3 or in the clavicular and shoulder regions. 4 Vein variations can cause resistance of catheter advancement. These variations could be congenital or acquired.When vessel distortions are suspected or confirmed, they should be avoided. Caution is required in sites with scar tissue, thoracic tumors, history of repeated catheter insertion, or extended dwell devices, with recommendations to reduce these events. 5 Therefore, applying a body maneuver to facilitate the advancement of the device is important. Maneuvers can be useful, safe, and feasible, contributing to patient safety and risk management 6 because they can facilitate tip positioning in the cavoatrial junction, preventing repeated procedures and enabling safe administration of infusion therapy through the CVCs, decreasing tissue injuries and iatrogenicity. For this reason, when tip placement of a CVC using noninvasive methods is necessary, maneuvering the shoulder 3 has been indicated, with the objective of facilitating the advancement of the CVC into the clavicular/shoulder region. 7 Not every CVC advances after performing some movement; however, several recommendations are made for this purpose, using several maneuvers of the shoulder, head, and neck for catheter advancement in the clavicular/shoulder region in children or adults. There is a need to evaluate the success of the insertion after the application of maneuvers for the advancement of the CVC in adult, pediatric, and neonatal patients. Thus, the research objective of this study was to verify the scientific evidence about maneuvers