Background and Goal of Study: Endotracheal tube displacement due to head and neck movement has been well described. We hypothesized that head and neck movement would also affect internal jugular catheter tip position. Changes in catheter position can sometimes lead to serious complications. The risk is particularly high in pediatric patients who are likely to move the head and neck. This study aimed to determine whether head and neck movement affects internal jugular catheter tip position in pediatric patients.
Materials and Methods: This retrospective study was performed between January 2014 and October 2017. All pediatric patients (aged 0-6 y) undergoing elective cardiac surgery were enrolled. Radiography was performed in both neutral and left head rotation positions. Using X-ray photography, we measured the change in distance between the catheter tip and the level of the 12th vertebral upper edge. Changes in catheter tip position between neutral and left head rotation position were analyzed using a paired t test. We defined clinically significant displacement as >1 cm.
Results and Discussion: The study enrolled 24 pediatric patients. Mean extent of movement was 0.18±0.89 (-1.58 to 2.42) cm (P =0.3). Maximum displacement of catheter tip position was 2.42 cm. Clinically significant catheter tip displacement (>1 cm) occurred in 25% of patients. Displacement occurred in an unpredictable manner (advancement in 4 patients, and withdrawal in 2). Our data showed that left head rotation did not significantly displace the catheter tip position in most cases. However, displacement of >1 cm still occurred in 25% of cases. Pediatric patients have difficulty holding the head and neck motionless, and the duration of catheter retention is shorter than that in adults.
Conclusion: In some cases, head and neck movement caused catheter advancement or withdrawal that could lead to severe complications. Factors that can affect catheter movement, such as puncture angle, puncture site on the neck, and fixed catheter position require further study.

08 / Change in internal jugular catheter tip position with head and neck movement. : A retrospective study