Left paramediastinal catheter position (differential)
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When a central venous catheter that is supposed to project overterminate in the superior vena cava or right atrium is abnormally located to the left of the mediastinum and below the level of the brachiocephalic vein, a limited differential of left paramediastinal catheter position should be considered 1:
- located within a vein
- located within an artery
-
descending thoracic aorta via the left subclavian artery
todescending thoracic aorta
-
descending thoracic aorta via the left subclavian artery
- extravascular position
- it is possible to inadvertently place a line directly into the mediastinum or pleural space
Malpositions such as these occur most commonly with catheters inserted via left internal jugular vein approach 2,3.
-<p>When a <a href="/articles/central-venous-catheter">central venous catheter</a> that is supposed to project over the <a href="/articles/superior-vena-cava">superior vena cava</a> is abnormally located to the left of the mediastinum a limited <strong>differential of left paramediastinal catheter position</strong> should be considered <sup>1</sup>:</p><ul>- +<p>When a <a href="/articles/central-venous-catheter">central venous catheter</a> that is supposed to terminate in the <a href="/articles/superior-vena-cava">superior vena cava</a> or <a href="/articles/right-atrium">right atrium</a> is abnormally located to the left of the mediastinum and below the level of the <a href="/articles/brachiocephalic-vein">brachiocephalic vein</a>, a limited <strong>differential of left paramediastinal catheter position</strong> should be considered <sup>1</sup>:</p><ul>
-<li><a href="/articles/left-sided-superior-vena-cava-1">left sided superior vena cava</a></li>- +<li><a href="/articles/left-sided-superior-vena-cava-1">persistent left superior vena cava</a></li>
-<li>located within an artery<ul><li>left <a href="/articles/subclavian-artery">subclavian artery</a> to <a href="/articles/descending-aorta">descending thoracic aorta</a>- +<li>located within an artery<ul><li>
- +<a href="/articles/descending-aorta">descending thoracic aorta</a> via the left <a href="/articles/subclavian-artery">subclavian artery</a>
-<li>extravascular position<ul><li>it is possible to inadvertently place a line directly into the <a title="Mediastinum" href="/articles/mediastinum">mediastinum</a> or <a href="/articles/pleural-space">pleural space</a>- +<li>extravascular position<ul><li>it is possible to inadvertently place a line directly into the <a href="/articles/mediastinum-1">mediastinum</a> or <a href="/articles/pleural-space">pleural space</a>
-</ul>- +</ul><p>Malpositions such as these occur most commonly with catheters inserted via left <a title="Internal jugular vein" href="/articles/internal-jugular-vein">internal jugular vein</a> approach <sup>2,3</sup>.</p>
References changed:
- 2. Ho ML, Bhalla S, Bierhals A et-al. MDCT of partial anomalous pulmonary venous return (PAPVR) in adults. J Thorac Imaging. 2009;24 (2): 89-95. <a href="http://dx.doi.org/10.1097/RTI.0b013e318194c942">doi:10.1097/RTI.0b013e318194c942</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19465830">Pubmed citation</a><span class="auto"></span>
- 3. Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. (2007) Intensive care medicine. 33 (6): 1055-9. <a href="https://doi.org/10.1007/s00134-007-0560-z">doi:10.1007/s00134-007-0560-z</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17342519">Pubmed</a> <span class="ref_v4"></span>
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