Introduction
Central venous catheters are intended for a variety of infusions, such as chemotherapy, administration of drugs or blood products, total parenteral nutrition, hemodialysis, and fluid replacement.1 For optimal function and avoidance of adverse effects, catheter tips must be positioned accurately within the central venous system. The region of highest blood flow velocity is desired because high blood flow at the tip leads to: the best drug distribution and dilution; lowest chance of occlusion rates; lowest chance of tip-related deep vein thrombosis (DVT); and the least catheter tip interference with the venous and right atrium (RA) walls.
Although there is controversy regarding optimal catheter tip position, it is generally understood that for most indications, the lower 1/3 of the SVC-CAJ is recommended as the ideal position in terms of function and low risk of complications.1
| Benefits of the lower 1/3 SVC-CAJ | |
|---|---|
 |
Furthest distance from the high risk areas |
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Largest vein diameter |
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Highest blood flow capacity |
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Minimal risk for catheter migration and looping |
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The catheter tip remains distant from the vessel walls |
Given an average SVC length of 7.0 cm, the lower third of the SVC is an average of
2.33 cm long. To reach the target area, a precision of ±1.1667 cm is needed. In addition, this region needs to be precisely reached at least 85% of the time, using a catheter that is, on average, 40 cm in length with a range of 32 cm to 55 cm.1
The lower 1/3 SVC-CAJ is the location recommended by several association guidelines.
Guidelines for Catheter Tip Placement
| Group | Guideline |
|---|---|
| AVA (1998) (Association of Vascular Access) | Lower 1/3 of SVC, SVC-RA Junction |
| ONS (2004) (Oncology Nursing Society) | Lower 1/3 of SVC-CAJ |
| INS (2006) (Infusion Nurse Society) | Lower 1/3 of SVC-CAJ |
| FDA CVC Working Group (1989, 1994) (Food and Drug Administration) | Lower 1/3 of SVC-CAJ Catheter tip should not be placed in or allowed to migrate into heart |
| SIR (2000) (Society of Interventional Radiologist) | SVC / RA Junction |
| NKF / KDOQI™ (2001) (National Kidney Foundation, Inc.) | SVC / RA Junction or RA |