[Location of the central venous catheter tip in the right atrium: description in 2348 critical patients]

Objective: to document possible complications related to the location of central venous catheter (CVC) tip in the right atrium (RA) in two medical-surgical intensive care units (ICU).

Design: An observational, retrospective study of critically ill patients.

Setting: two medical-surgical ICUs.

Patients: adult patients in need of CVC insertion admitted consecutively in ICU between September 2004 and September 2009.

Main variables: Gender, age, condition at admission, severity scale (APACHE II), days with catheter, in addition to clinical variables associated with perforation, cardiac tamponade and death attributable to catheter.

Results: 2581 patients were included in the study; with mean age of 50.2 years (SD ± 20). Out of these, 2348 (91%) remained with the tip in the RA territory and 233 (9%) in superior vena cava (SVC). Arrhythmias were registered during insertion of the guide in 51.2% with the tip in RA and 46.5% with the tip in SVC, p=0.18. A total of 14.5% of the patients with the tip in the RA had arrhythmias during their stay in the ICU and 14.6% of the patients with the tip in SVC, (p=0.95). No statistically significant differences were found between the average days in the ICU, days with catheter, APACHE II, mortality in general or attributable to catheter of patients with CVC in RA compared with those with the catheter tip located in the SVC.

Conclusions: no difference was found in the incidence of complications that could be related to having the catheter in RA or in the mortality attributable to catheter compared to the patients who had the tip in the SVC.