Radiological evaluation of central venous catheter tip malposition

Background: Malposition of central venous catheters is a potentially severe but often preventable complication. This study aimed to assess the radiological distribution of central venous catheter tip positions and to discuss malposition mechanisms based on anatomical and radiographic literature.Methods: A retrospective analysis of 374 patients who underwent intraoperative central venous catheter insertion between January 2022 and December 2023 was conducted. Radiographs were evaluated using a carina-based classification system: Zones A–C (normal) and Zone D (malposition). Data were analyzed retrospectively.Results: The right internal jugular vein was the most commonly preferred access site, used in 80.0% of cases. Zone A: 52.3%, Zone B: 18.5%, Zone C: 17.8%, Zone D (malposition): 11.4%. There was no statistically significant association between catheter size and malposition (p>0.05).Conclusion: Utilizing the carina as a reference point during post-procedural imaging is essential for accurate catheter tip localization. Adjunctive modalities—including intracavitary ECG, ultrasound, and radiography—contribute to complication reduction and procedural safety.