Prevalence and consequences of central venous catheter malposition in critically ill pediatric patients

Background: This study aimed to determine the prevalence of malpositioning of central venous catheters inserted into the internal jugular and subclavian veins and to identify the risk factors associated with such positioning in children. Methods: A retrospective cohort study in a pediatric intensive care unit (ICU) radiologically assessed central venous catheters (CVC) position in patients aged one month to 18 years from 2023 to 2024. Positioning was categorized based on proximity to the carina: “Good” (between the carina and two vertebral bodies below), “High” (above the carina), “Low” (below two vertebral bodies) and “Abnormal” (outside these regions). The associations between patient demographics, clinical data, and catheter tip positions were analyzed. Results: Out of 214 pediatric patients, 52.8% were males, with a median age of 35 months. Catheter tip positioning was classified as “good” (62.1%), “high” (17.7%), “low” (17.2%) and “other” (2.8%). Notably, High tip positions were associated with older and heavier patients, while Low tip positions were more common in younger and lighter patients. Patients weighing 20–40 kg had nearly three times higher odds of “High” catheter tip positions than those weighing 0–10 kg (p = 0.032). Temporary CVCs were five times more likely to result in “High” positions (p = 0.035). Right-sided placement reduced the risk of “High” positions by 71% (p = 0.002). In comparison, higher weight categories (10–20 kg and ≥40 kg) lowered the odds of “Low” positions by 79% and 74%, respectively (p = 0.004 and p = 0.025). Conclusions: In critically ill pediatric patients, the incidence of malposition in CVCs remains significantly high, influenced by factors type and location of catheter placement, direction of insertion and the patient’s age and weight.

Central venous catheter malposition; Pediatric ıntensive care; Pediatric catheterization

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