• Joshua Gish, Tiffany Wright, Samir Gadepalli, and Marcus Jarboe.
• Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI. Electronic address: gishj@med.umich.edu.
• J. Pediatr. Surg. 2016 Aug 1; 51 (8): 1336-40.

BackgroundSuboptimal position of tunneled central venous catheters (Broviacs) decreases long-term catheter longevity, incurring morbidity and cost. We postulated that catheter malposition is related to patient's age, technique used, and initial catheter tip location (CTL).MethodsWe performed a retrospective review with 1-year follow-up of Broviacs placed in patients at our children's hospital from 3/2010 to 10/2013. We defined malposition as a noncentral CTL that required replacement, excluding catheters physically dislodged. We used logistic regression to determine whether age, technique and CTL predicted malposition with p-value<0.05 deemed significant. We analyzed line longevity for different insertion techniques by survival analysis.ResultsOverall, 404 upper body Broviacs were placed in 282 children (median age=1.4years [IQR:0.45-5.35]). Thirty-six (8.9%) were replaced for malposition, at median of 84.5days [IQR:36-159]. We found that older children were less likely to develop malposition (OR=0.91,p=0.002). Adjusting for patient age and placement technique, catheters placed ≥1.5 vertebral bodies below the carina were less likely to be malpositioned (OR=0.37,p=0.015). Cox-regression shows the lateral technique to have the lowest rate of malposition within 90days (HR=0.30,p=0.03).ConclusionOlder patients and lines placed 1.5 vertebral bodies below the carina are less likely to become malpositioned. Using the lateral approach for insertion improves catheter longevity.Copyright © 2016 Elsevier Inc. All rights reserved.

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