Evaluation of the positioning of double central venous catheters and malpositionratios in cardiac surgery

ntroduction: The central venous catheter malposition ratio is 6.7% and it is lower for the rightinternal jugular vein (4.3%). Our study aims to determine the positions of the introducer andthe central venous catheter simultaneously placed into the right internal jugular vein as well astheir malposition ratios in cardiac surgery.Method: The central venous catheter positioning was retrospectively examined in the patientswho underwent a cardiac operation between 2012 and 2016. The ideal place for the tip of thecatheter was divided into two zones over the carina: Zone A, upper right atrium and lowersuperior vena cava (SVC) and Zone B, upper SVC and junction of the right innominate vein.The tip of catheter positioned below the carina was evaluated as Zone C (in the right atrium),whereas the positioning of a catheter outside the superior vena cava was considered amalposition. Results: Of 392 patients, 133 had the catheter tip on Zone A, 121 on Zone B, and 99 on ZoneC, whereas the malposition number (Zone D) was 39 (9.94%). The most frequently observedwrong placement was vena cava inferior. When the patients were divided into two groups as<165 cm (short, n=190) and >165 cm (tall, n=202) by their height, the number of Zone A (theideal place) patients was low among the short patients, while malposition was higher (27 vs12). Discussion and Conclusion: There is no literature showing the effect of the double catheter onmalposition, and we have the first study to work on this field. In our study, vena cava inferiormalposition was more frequent with two catheter application in the same right internal jugularvein. Depending on the results of our study, we think that the catheter tip malposition ratio ishigher in the short patients in particular. However, there is a need for randomized prospectivestudies