title: Transfemoral repositioning of malpositioned central venous catheters.
abstract: OBJECTIVE
  To determine the efficacy of the transfemoral vein approach to repositioning malpositioned central venous catheters.
  
  
  METHODS
  During a 4(1/2)-year period, malpositioned central venous catheters were repositioned 91 times in 83 patients via the transfemoral vein approach. All repositioning was initially attempted with a Grollman catheter or other pigtail catheter and a tip-deflecting wire. If these techniques failed or the venous anatomy was unfavorable, gooseneck or long loop snares were used.
  
  
  RESULTS
  During 48 repositionings, rotating a pigtail-type catheter alone was used successfully in 39 (81%). In 6 of 9 failures, the addition of a tip-deflecting wire also failed. A Grollman catheter and tip-deflecting wire were used initially in 39 repositionings (6 failures; 85% success). Successful repositioning required a snare in 8 (4 as the primary repositioning technique) and a long-loop technique in 5. All repositionings were ultimately successful and there were no complications.
  
  
  CONCLUSIONS
  Central venous catheters can be repositioned consistently by the transfemoral route. Pigtail catheters or tip-deflecting wires alone are successful in over 80% of cases.
authors.affiliation: Department of Radiological Sciences, Deaconess Hospital and Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, USA.
authors.forename: G G
authors.initials: GG
authors.lastname: Hartnell
authors.forename: J
authors.initials: J
authors.lastname: Gates
authors.forename: J N
authors.initials: JN
authors.lastname: Suojanen
authors.forename: M E
authors.initials: ME
authors.lastname: Clouse
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D005268:Femoral Vein; D005471:Fluoroscopy; D006801:Humans; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012399:Rotation; D013499:Surface Properties