Primary and secondary malposition of silicone central venous catheters.

We reviewed our experience with the percutaneous insertion of 459 silicone central venous catheters from 1979 to 1984. Special attention was given to the complication of malposition of these catheters. From 1981-1984, 116 consecutive percutaneous silicone central venous catheters (CVC) were inserted using the peel away sheath introducer. There were no primary catheter malpositions using this technique; however, secondary malposition occurred with 6% of the catheters. In addition to the use of this technique, patient response to movement of the guidewire during the catheterization procedure is described. The details of catheter insertion technique which permit operative assessment of the correctness of catheter location are presented. Symptoms and signs of secondary catheter malposition, as well as management required for this problem, are discussed.