Registered Nurses' Association of Ontario

Central Venous Access Device (CVAD) Placement and Potential Complications

  • Nurses will not use the central venous access device (CVAD) until tip placement has been confirmed.
  • Following insertion, the exact anatomical position of the CVAD must be determined radiographically and documented prior to the initiation of any therapy through the device.
  • Optimal tip position for all CVAD to be the distal Superior Vena Cava (SVC) and/or the caval/atrial junction.
  • Nurses must be aware of the tip position of all CVAD in order to monitor the patient for potential complications and CVAD functionality.
  • Three complications caused directly by incorrect tip position include:
    • Central venous perforation;
    • Thrombosis; and
    • CVAD dysfunction.
  • Clients whose CVAD tip rests within the middle to upper SVC, in the brachiocephalics or in the periphery are at higher risk for catheter-related thrombosis.
  • On average, all peripherally inserted central catheters (PICCs) will move at least two centimetres (cm) caudal (away from the head) with arm movement.
  • Catheters inserted via the subclavian or jugular veins will move on average two to three cm cephalad (toward the head).
  • At a minimum, the tip position should be checked radiographically if the CVAD functionality changes and/or signs and symptoms of complications are observed.
  • Nurses need to seek expert advice and advocate on the client’s behalf for other appropriate tests in order to troubleshoot CVAD functionality. Some of these procedures include:
    • X-ray to verify tip position;
    • Dye study as indicated;
    • Ultrasound and/or Doppler ultrasound; and
    • Fluoroscopy.
  • To view an example visual representation of the correct tip position of a tunneled CVAD click here.
Clinical Management
Care and Maintenance to Reduce Vascular Access Complications
Point of Care Resources