Central venous catheter tip position and risk of mechanical complications: a systematic review and meta-analysis.

Authors

Eriya Imai, Hiromu Okano, Mitsutaka Edanaga, Yoshimasa Takeda, Michiaki Yamakage, Joho Tokumine

Published in

Journal of anesthesia. Sep 04, 2026. Epub Sep 04, 2026.

Abstract

The optimal central venous catheter (CVC) tip position remains controversial. Shallow placement above the pericardial reflection was recommended to avoid cardiac tamponade, whereas recent practice has favored positioning near the cavo-atrial junction (CAJ) to reduce risks of thrombosis and catheter dysfunction. We compared complications across tip positions: Zone A (CAJ/lower superior vena cava [SVC]/upper right atrium), Zone B (upper SVC), and Zone C (left brachiocephalic vein). We searched MEDLINE, Embase, CENTRAL, Ichushi-Web, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to January 2026. We included randomized and non-randomized studies comparing CVC tip positions in adults. Two reviewers screened studies and assessed risk of bias. Random-effects meta-analyses synthesized adjusted odds ratios (ORs) and crude risk ratios (RRs). Certainty was assessed using GRADE. Fifteen studies (9,589 participants; 9,815 catheters) were included. Compared with Zone B, Zone A probably reduces catheter-related thrombosis in adjusted analyses (OR 0.17; 95% confidence interval [CI] 0.05-0.59) and may reduce thrombosis in crude analyses (RR 0.14; 95% CI 0.03-0.55). Zone A may also reduce the risk of catheter occlusion or dysfunction compared with Zone B (RR 0.44; 95% CI 0.23-0.82). For thrombosis, Zone C may show little-to-no difference compared with Zone B, whereas the comparison between Zones C and A is highly uncertain. Mortality and cardiac tamponade were not estimable. CAJ positioning (Zone A) may lower thrombosis and catheter dysfunction compared with upper SVC positioning (Zone B). Evidence on rare severe complications remains uncertain. TRIAL REGISTRATION: PROSPERO (CRD420261292506).

PMID:
42696161
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.