Misplacements of Central Venous Catheters: Internal Jugular Versus Subclavian Access in Critical Care Patients

Abstract

Aim; In central venous catheterization (CVC), misplacement is not a rare complication since this is a blinded procedure. The aim of this study was to compare the misplacement risks of the access of internal jugular vein with that of subclavian vein catheterizations. Methods;The records of a total of 1092 patients in whom central venous catheters were placed between 2002 and 2006 in Anesthesiology Intensive Care Unit and the location of the tips was confirmed radiologically were retrospectively evaluated. Neck and infraclavicular region were cleaned by antiseptic solution after routine monitorization. CVC were easily inserted with Seldinger's technique after blood aspiration through internal jugular vein or subclavian vein. Results; In adult patients, six internal jugular catheter misplacements were seen (0.80%); among them five were kinking and one was intrapleural location of the catheter tip. Six subclavian misplacements (2.02 %) were detected, five of them were located in contralateral subclavian vein, and one was located in ipsilateral internal jugular vein. In children, two subclavian misplacements were seen as crossing to contraleteral subclavian vein, and there were no internal jugular misplacement. There was no statistically difference for misplacement between the access sites (in adult p= 0.110, in children p=0.501). Conclusion; We have concluded that experience of operator should be taken into account for choice of catheterization site.