Sun28November0440PM 29

You have admitted a 45-year-old man onto the intensive care unit with sepsis of unknown cause.

A left sided internal jugular central venous catheter has been inserted and you are reviewing the chest radiograph to check the position of the tip of the catheter.

What is the safest position to leave the catheter tip?

(Please select 1 option)

In the right innominate vein

In the right atrium

In the left innominate vein

In the lower superior vena cava This is the correct answer

In the upper superior vena cava Incorrect answer selected

Explanation

If the catheter tip is above the carina on a post-procedure radiograph then it is generally accepted that the catheter lies outside the right atrium in the lower superior vena cava (SVC). It is also recommended that the catheter tip should lie in the long axis of the SVC without acute abutment to the vein wall.

Left sided catheters are more likely to erode the vessel wall if they lie in the innominate veins or the upper SVC due to the abutment of the catheter tip to the vessel wall. They are also more likely to cause pain on injection, thrombosis and infection if the tip lies in the innominate veins.

It is considered negligent to site the catheter tip in the right atrium as this may lead to arrhythmias, tricuspid valve disfunction and placement in the coronary sinus.

Reference:

Stonelake PA, Bodenham AR. The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth. 2006;96:335-40.

Answer Statistics

1

1%

2

6%

3

2%

4

73%

5

20%

Times answered: 244