Malpositioning of the central venous catheter (CVC) tip is a common complication of CVC placement. Undiagnosed CVC tip malpositioning can lead to significant morbidity and mortality. The management in cases of CVC tip malpositioning is to remove and relocate the catheter.1 In everyday practice, the correct placement of the CVC tip within the superior vena cava (SVC) usually is confirmed by aspiration of blood from the distal port, transduction of waveform consistent with intravenous placement, and careful interpretation of chest radiograph. Alteration in central venous pressure (CVP) waveform morphology in the presence of inconclusive chest radiograph should be evaluated with additional diagnostic methods to rule out CVC malposition. We report a case where intrathoracic pressure waveform transduced from the CVC with chest radiograph inconclusive of intracaval placement was investigated with transesophageal echocardiography (TEE) to confirm the placement of the CVC tip within the SVC.
Reference:G.N. C., Sruthi, S., Kale, S.B. and Ramasamy, P. (2020) Intrathoracic Pressure Waveform Transduced From Central Venous Catheter Tip: To Remove or Reposition the Catheter? Journal of Cardiothoracic and Vascular Anesthesia. January 16th. doi: 10.1053/j.jvca.2020.01.013. (Epub ahead of print).