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Superior vena cava (including brachiocephalic - SVC junction)
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Right atrium
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Inferior vena cava
Central venous catheter with tip in the inferior vena cava
All other locations for central venous catheter tips are considered peripheral with maximum osmolarity (900-1000 mOsm/L).
Click here for Parenteral Nutrition Osmolarity Calculator
Several factors known to increase risk of phlebitis, thrombosis, thrombophlebitis, infiltration, and extravasation when infusing high osmolarity solution including:
- suboptimal tip location
- patient condition
- infusion solution
ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002 Jan-Feb;26(1 Suppl):1SA-138S. Erratum in: JPEN J Parenter Enteral Nutr 2002 Mar-Apr;26(2):144. PubMed PMID: 11841046.
Click here for related Clinical Vignette
Proper central venous catheter placement
Non-central location of venous catheter tip
Non-central location of venous catheter tip
Non-central location of venous catheter tip
Non-central location of venous catheter tip
Non-central location of venous catheter tip
Social Media
From Home Parenteral Nutrition Program at Boston Children's Hospital Facebook Group on July 17, 2015 https://www.facebook.com/groups/HPNBostonChildrens/permalink/419813568223961/
"How often do we recommend checking X-ray to confirm central line tip location? In general for children on chronic HPN with functioning central lines, we recommend checking an X-ray to confirm the line tip location:
- Whenever a new line is placed (even if done somewhere else),
- Once per year, child is - Every 2 years, ages 2-16,
- Whenever clinically indicated, age >16,
http://bit.ly/1MyL4iX"
