title: Assessment of distal tip position of long-term central venous feeding catheters using transesophageal echocardiology.
abstract: BACKGROUND
  Central vein catheter position is a vital element in promoting longevity and minimizing adverse events associated with long-term parenteral nutrition. Traditionally, position has been verified using a chest radiograph. However, this mode of assessment has limitations as the catheter is placed in a dynamic system subject to forces from changes in posture and diaphragmatic movement.
  
  
  METHODS
  We compared the reported position using a chest x-ray compared with assessment using transesophageal echocardiology (TOE) in 9 patients receiving home parenteral nutrition. The x-ray was reported by a radiologist unaware of the study.
  
  
  RESULTS
  There were discordant results in 7 of the 9 cases with catheter tip placed in the right atrium or impinging in the tricuspid valve which was not evident from the chest x-ray. TOE offered greater information of catheter tip position and relationship to adjacent anatomy.
  
  
  CONCLUSIONS
  Further work is required but this observational study suggests guidelines suggesting the use of a chest radiograph to confirm catheter position may need to be re-assessed.
authors.affiliation: Department of Digestive Disease and Clinical Nutrition, Ninewells Hospital and Medical School, Dundee, Scotland. drreynolds@angus-nhs.finix.org.uk
authors.forename: N
authors.initials: N
authors.lastname: Reynolds
authors.forename: A S
authors.initials: AS
authors.lastname: McCulloch
authors.forename: C R
authors.initials: CR
authors.lastname: Pennington
authors.forename: R J
authors.initials: RJ
authors.lastname: MacFadyen
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005471:Fluoroscopy; D006801:Humans; D016331:Parenteral Nutrition, Home; D013902:Radiography, Thoracic; D014743:Videotape Recording