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LETTER TO THE EDITOR
Year : 2015  |  Volume : 8  |  Issue : 1  |  Page : 3-4

Malfunctioning of central venous catheter in obese patients


Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences (A.I.I.M.S.), Gautam Nagar, New Delhi, India

Date of Submission16-Sep-2014
Date of Acceptance25-Jan-2015
Date of Web Publication25-Mar-2015

Correspondence Address:
Girija P Rath
Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences (A.I.I.M.S.), Gautam Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.153927

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How to cite this article:
Sharma A, Hamsenandinie, Rath GP. Malfunctioning of central venous catheter in obese patients. Ain-Shams J Anaesthesiol 2015;8:3-4

How to cite this URL:
Sharma A, Hamsenandinie, Rath GP. Malfunctioning of central venous catheter in obese patients. Ain-Shams J Anaesthesiol [serial online] 2015 [cited 2021 May 6];8:3-4. Available from: http://www.asja.eg.net/text.asp?2015/8/1/3/153927

Malposition following central venous catheter (CVC) insertion is not uncommon, and has been reported in a large number of cases. We report yet another cause of CVC malposition for an atypical reason in a 38-year-old obese (BMI 32 kg/m 2 ) female posted for excision of cerebellopontine angle tumor. After standard anesthetic induction, a triple lumen CVC (7 Fr, Certofix trio V720; B Braun, Melsungen, Germany) was inserted in the right subclavian vein using the landmark technique and was fixed at 12 cm, under all aseptic precautions. All three ports were checked for free flow of blood, and then flushed and connected to the pressure transducer, which showed a typical central venous pressure waveform. However, the definitive surgery was postponed following gross hemodynamic changes owing to surgical reasons. After stabilization and subsequent evaluation of cardiac conditions, the patient was again posted for the same surgery 2 days later. In the operating room, all routine monitors were attached, and the patency of CVC was checked. On aspiration, the free flow of blood was absent in all ports, except the distal one. Blockade of the CVC ports was presumed owing to clotting of blood, and hence a change of the CVC over the guidewire was planned. The new CVC was placed at same length as the previous one (i.e. 12 cm), but there was no free flow of blood from any of these ports except the distal one. At that time, the chest radiography of the patient taken after the insertion of first CVC was examined. It showed curling of the CVC at the level of the clavicle due to the subcutaneous fat and bulky breast tissue ([Figure 1]). Thereafter, the CVC was inserted further and blood was aspirated at each centimeter of insertion; a free flow of blood was obtained at 15 cm from all three ports and was fixed at that point.
Figure 1: Curly path (arrow) of the central venous catheter in an obese patient.

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In this case, the CVC was fixed at 12 cm at the first instance, which was functional, but became nonfunctional due to the curling of the catheter, owing to the fat and bulky breast tissue. Thus, when the CVC was inserted for the second time, it might have followed the similar curly pathway of the previous procedure. Hence, a free flow of blood was not obtained at similar length of insertion, which made us to insert up to 15 cm. Apparently, in obese and female patients with bulky breast tissue, insertion of CVC, through the infraclavicular subclavian venous route, at a conventional length (i.e. 11-12 cm) [1] may not be appropriate. The catheter may assume a curly pathway over a time period, with the displacement of the fatty tissue. As the outer end is fixed with skin, the vascular (inner) end may come out of the vessel giving the impression of blocked ports or catheter malposition. Insertion of CVC to an extra length of 2-3 cm may prevent such malposition in obese patients; however, a randomized trial in this regard may provide more insight.


  Acknowledgements Top


Conflicts of interest

None declared.

 
  References Top

1.
Rath GP, Bithal PK, Toshniwal GR, Prabhakar H, Dash HH. Saline flush test for bedside detection of misplaced subclavian vein catheter into ipsilateral internal jugular vein. Br J Anaesth 2009; 102:499-502.  Back to cited text no. 1
    


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