Ensuring Precision in Central Venous Access: A Review of Catheter Malposition and Patient Safety

Purpose: Central venous catheterization (CVC) is essential in emergency and critical care practice, yet catheter malposition remains a clinically significant complication.This review aims to provide a structured overview of the mechanisms, classification, diagnostic approaches, and management strategies for CVC malposition, with emphasis on patient safety.Materials and methods: A narrative literature review was conducted using PubMed, Scopus, and Google Scholar from inception to December 2025.Articles addressing anatomical mechanisms, imaging diagnosis, and management of CVC malposition in adult patients were included.Relevant references were also hand-searched to ensure completeness.Results: Catheter malposition occurs in 3-7% of insertions despite ultrasound guidance.Malpositions are classified as intravascular (venous or arterial) or extravascular.Clinical consequences range from catheter dysfunction to life-threatening complications such as hemorrhage or cardiac tamponade.Chest radiography (CXR), ultrasound, intracavitary electrocardiographic (IC-ECG), fluoroscopy, and computed tomography (CT) play complementary roles in diagnosis.Evidence supports avoiding blind catheter removal, particularly in arterial or extravascular placement, where specialist-guided intervention is required.Conclusion: Early recognition of catheter malposition, appropriate imaging confirmation, and structured management pathways are essential to prevent catastrophic complications.Multidisciplinary involvement and emerging real-time tip-confirmation technologies can further enhance procedural safety in emergency and intensive care settings.