• Mark D Weber, Thomas Conlon, Charlotte Woods-Hill, Stephanie L Watts, Eileen Nelson, Danielle Traynor, Bingqing Zhang, Daniela Davis, and Adam S Himebauch.
• Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA.
• Pediatr Crit Care Me. 2022 Mar 1; 23 (3): 192200192-200.

ObjectivesThe primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients.DesignSingle-center retrospective cohort study.SettingQuaternary academic PICU.PatientsChildren greater than 1 month to less than 18 years who had a CVC placed between January 2014 and December 2018.InterventionsNone.Measurements And Main ResultsThe primary outcome was the CVC tip position located on the first postprocedural radiograph. CVC tip was defined as follows: "recommended" (tip location between the carina and two vertebral bodies inferior to the carina), "high" (tip location between one and four vertebral bodies superior to the carina), "low" (tip position three or more vertebral bodies inferior to the carina), and "other" (tip grossly malpositioned). Seven hundred eighty-one CVCs were included: 481 (61.6%) were in "recommended" position, 157 (20.1%) were "high," 131 (16.8%) were "low," and 12 (1.5%) were "other." Multiple multinomial regression (referenced to "recommended" position) showed that left-sided catheters (adjusted odds ratio [aOR], 2.00, 95% CI 1.17-3.40) were associated with "high" CVC tip positions, whereas weight greater than or equal to 40 kg had decreased odds of having a "high" CVC tip compared with the reference (aOR, 0.45; 95% CI, 0.24-0.83). Further, weight category 20-40 kg (aOR, 2.42; 95% CI, 1.38-4.23) and females (aOR, 1.51; 95% CI, 1.01-2.26) were associated with "low" CVC tip positions. There was no difference in rates of central line-associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between the CVCs with tips outside and those within the recommended location.ConclusionsThe prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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