title: Placement of central venous catheters in patients undergoing major maxillofacial surgery - a retrospective clinical audit.
abstract: OBJECTIVE
  The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40 degrees to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40 degrees to the superior vena cava wall.
  
  
  METHODS
  Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long.
  
  
  RESULTS
  82% of the catheter tips were located above the carina while 61% were angulated at greater than 40 degrees ; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards.
  
  
  CONCLUSIONS
  89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.
authors.affiliation: Northampton General Hospital NHS Trust, Northampton, UK. vasileioszochios@doctors.org.uk
authors.forename: Vasileios
authors.initials: V
authors.lastname: Zochios
authors.forename: Michael
authors.initials: M
authors.lastname: Gilhooly
authors.forename: Simon
authors.initials: S
authors.lastname: Fenner
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling; D004739:England; D004867:Equipment Design; D019983:Guideline Adherence; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D008485:Medical Audit; D019647:Oral Surgical Procedures; D017410:Practice Guidelines as Topic; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D016896:Treatment Outcome