- Initial malposition of catheter tip
- Port not accessed
- Port leaking
- Catheter broken
- Catheter leaking
- Catheter tip migrated and occluded against wall of vessel
- Catheter tip migrated out of vessel
- Fibrin sheath at catheter tip
- Thrombus at catheter tip
- Retained / embolized catheter fragment after catheter removal
- Retained / embolized fibrin sheath after catheter removal
Approach to the differential diagnosis of central venous catheter malfunction:
- First look at the CXR scout image to determine if
— Port not accessed
— Catheter broken
— Catheter tip migrated and occluded against wall of vessel
— Catheter tip migrated out of vessel - Second fill the catheter with contrast to determine if
— Port leaking
— Catheter leaking - Third inject contrast through the catheter focusing on the catheter tip to determine if there is
— Fibrin sheath at catheter tip (Note: fibrin sheaths can be subtle)
— Thrombus at catheter tip - Finally realize that high density tubular structures on CXR scout images can be
— Retained / embolized catheter fragment after catheter removal
— Retained / embolized fibrin sheath after catheter removal