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Can chest X ray confirm the right position of the central venous catheter?
  • Published: 01 March 2012
  • Volume 26, pages 141–142, (2012)
  • Cite this article
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Editor,

I read with the great interest the article by Umesh et al. [1] on utilizing carina as a radiological landmark for detection of accidental arterial placement of a central venous catheter (CVC). The article demonstrates AP view chest X ray (CXR) is a simple and convenient tool in distinguishing arterial from venous placement. However, it doesn’t seem to work in our patient. I wish to report a case in our emergency department.

A 87-year-old woman was referred to our hospital under the impression of septic shock. CVC was inserted from left neck area and inadvertent internal jugular artery placement was confirmed by the blood gas test thereafter. Pig tail catheter was inserted for left pneumothorax. Another CVC was placed in the right subclavian vein via the infraclavicular approach. AP view CXR showed the two CVC tip, both in the same position (Fig. 1). Chest computer tomography revealed one CVC in the superior vena cava (SVC) and the other in the ascending aorta (Fig. 2). Coronal section also showed one CVC is in the ascending aorta (Fig. 3) and the other is in the SVC (Fig. 4). Her disease deteriorated and she was discharged under critical condition on the 3rd day of admission.

Fig. 1
figure 1

Chest x ray

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Fig. 2
figure 2

a Ascending aorta. b Superior vena cava

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Fig. 3
figure 3

CVC in ascending aorta

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Fig. 4
figure 4

CVC in SVC

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The placement of CVC is a routine procedure which usually performed in critical ill patients. Arterial puncture, hematoma, and pneumothorax are the most common mechanical complications during the insertion of central venous catheters. The use of blood flow and color criteria were not always reliable in detecting arterial puncture [2]. Even drawing the blood gas from the CVC and compared to a distant arterial sample provides limited information. Identification by transducing and viewing the waveform is most precise. There is no single method that warrants conformation of proper position of CVC. Since the patient doesn’t position at the proper angle, the miscarriage of justice of the CXR probably ensues.CXR is one kind of these methods in assisting with position distinction but may be not an ideal tool in distinguishing arterial from venous placement when utilized solely.

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References

  1. Umesh G, Ranjan S, Jasvinder K, Nanda S. Carina as a useful and reliable radiological landmark for detection of accidental arterial placement of central venous catheters. J Clin Monit Comput. 2010;24:403–6.

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  2. Jobes DR, Schwartz AJ, Greenhow DE, et al. Safer jugular vein cannulation: recognition of arterial puncture and preferential use of the external jugular route. Anesthesiology. 1983;59:353.

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Authors and Affiliations

  1. Department of Emergency Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan

    Chia-Wei Lin & Chun-Kai Tseng

Authors
  1. Chia-Wei LinView author publications

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  2. Chun-Kai TsengView author publications

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Correspondence to Chia-Wei Lin.

Additional information

For response please refer Goneppanavar Umesh et al. (doi:10.1007/s10877-012-9345-1 )

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Lin, CW., Tseng, CK. Can chest X ray confirm the right position of the central venous catheter?. J Clin Monit Comput 26, 141–142 (2012). https://doi.org/10.1007/s10877-012-9343-3

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  • Received: 11 October 2011

  • Accepted: 17 February 2012

  • Published: 01 March 2012

  • Issue date: April 2012

  • DOI: https://doi.org/10.1007/s10877-012-9343-3

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Keywords

  • Pneumothorax
  • Central Venous Catheter
  • Superior Vena Cava
  • Arterial Puncture
  • Left Pneumothorax
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