Central line placement referrals to the Radiology department – A 5 year study

M Syed, D Ettles

Hull & East Yorkshire NHS Trust

Problem: Central venous catheters have traditionally been placed by surgeons or physicians under general anaesthesia or sedation, without imaging to guide venous puncture or assess final position. In these circumstances, malposition of catheters can be expected in 6% of patients.

Purpose: We review the role of interventional radiology in the management of central catheters over a 5-year period in our institution.

Design: Retrospective data analysis was performed using interventional case registers and departmental computer records. All Patients referred to the radiology service for central line placement or manipulation were included.

Findings: 86 patients were referred, the majority (70%) following surgical line placement. 48 of these were referred because of malpositioned catheters and the remainder for radiologically guided central line insertion. Referral rates increased sharply, with over 80% of cases referred in the second half of the study period.

In all except 2 cases, procedures were performed under local anaesthesia. Over 50% of line repositioning was completed in < 30 minutes, with a longest procedure time of 2 hrs. Over >75% of line insertions were completed within 1 hr. There were no reported major or minor complications but one procedure was abandoned due to the presence of tesio line fragments embedded within the wall of the superior vena cava.

Conclusion: Imaging guided catheter insertion and manipulation is safe and reliable with negligible complications. Increased clinician awareness has resulted in greater referral rates. Appropriate training of non-radiology clinicians to reduce the incidence of catheter malposition is suggested.

Relevance: Interventional radiology has a key role in central line placement and management of failed or malpositioned catheters