Pediatric Subclavian and Femoral Venous Catheter Malfunction

  • Etiology: Placed in patients who need central venous access
  • Imaging:
    — Correct subclavian venous line tip position is in the superior vena cava
    — Correct femoral venous line tip position is in the femoral vein or inferior vena cava
    — If catheter is extravascular see widened mediastinum from hematoma or mediastinal pooling of contrast after contrast injection
    — Note: If a line is placed with its tip in the hemiazygos vein it should not be considered to be central
  • DDX:
  • Complications:
    — Catheter tip not positioned in the subclavian vein or superior vena cava
    — Catheter tip not positioned in the femoral vein or inferior vena cava
    — Catheter tip in the right atrium which can lead to erosion of tip through right atrium into pericardial space causing cardiac tamponade
    — Catheter placed in artery rather than in vein
    — Catheter perforation of vein during placement
    — Catheter tip thrombosis which can extend into any adjacent vein
    — Retained or embolized catheter fragment
  • Treatment: Repositioning or replacement of malpositioned catheter
  • Clinical:

Radiology Cases of Subclavian and Femoral Venous Catheter Malfunction

Radiology Cases of Subclavian Venous Catheter Malposition in the Pericardial Space Causing Pericardial Effusion and Cardiac Tamponade

CXR of pericardial effusion due to malposition of central line in the pericardial space
CXR AP (left) shows the tip of the newly placed left subclavian venous catheter to project deep within the right atrium while the cardiac silhouette is normal in size. CXR AP 2 days later (right) shows the catheter tip unchanged in position while the cardiac silhouette has increased markedly in size in the interval. Cardiocentesis returned TPN.
CXR of pericardial effusion due to catheter perforation into pericardial space
CXR AP obtained after left subclavian line placement (above) shows the tip of the line in the right atrium. CXR AP obtained 3 days later during the episode of cardiac decompensation (below) shows interval enlargement of the cardiac silhouette. ECHO showed the subclavian line had perforated into the pericardial space resulting in a hemopericardium.

Radiology Cases of Femoral Venous Catheter Perforation of Femoral Vein

Venogram of perforation of femoral venous catheter out of the femoral vein
AXR AP (left) shows a left femoral venous catheter whose tip projects to the left of the L5 vertebral body, rather than projecting near the middle of the L5 vertebral body. AP venogram taken after injecting contrast through the femoral catheter (right) shows extravasation of contrast into the soft tissues surrounding the catheter tip.

Radiology Cases of Femoral Venous Catheter Thrombus

Line study showing thrombosis of a femoral venous catheter
AXR lateral (above) shows the tip of the left femoral venous catheter to be in the inferior vena cava. AP (below left) and lateral (below right) images after injection of the catheter show contrast opacifying a long non-occlusive thrombus in the inferior vena cava from the T10-L1 vertebral bodies.