Validating the anatomical landmark technique for bedside tunneled central venous catheter placement in the medical intensive care unit

Background: A non-tunneled dialysis catheter (nTDC) is often the vascular access of choice to initiate dialysis in an intensive care unit (ICU). In the absence of contraindications, if a patient remains dialysis dependent beyond 2-weeks, the options are either to replace the nTDC with another nTDC or convert to a tunneled dialysis catheter (TDC). As a standard of care, TDCs are placed under fluoroscopic guidance. Objectives: To determine if TDCs and other tunneled central venous catheters (tCVC) can be placed safely using anatomical landmark techniques without the use of fluoroscopy. Research design: Subjects that met a predetermined selection criteria underwent placement of tunneled catheters with the use of the anatomical landmark technique. We looked at various outcomes to determine the safety and effectiveness of this technique. Subjects: One hundred eleven TDCs and other tCVCs were placed using the anatomical landmark technique in the intensive care unit. Results: All but one (110/111) of the catheters placed had recommended tip placement confirmed by at least one blinded physician. Major complications encountered were bleeding (two cases), pneumothorax (one case), and line associated blood stream infection (one case). We did find a higher-than-expected rate of “unnecessary procedures” with 18/111 lines placed in patients who did not survive beyond 7 days after placement of the catheter. Conclusions: Using the anatomical landmark technique for bedside tunneled catheter placement can be an effective approach in the right population.