ReviewJournal of anesthesia2026
Central venous catheter tip position and risk of mechanical complications: a systematic review and meta-analysis.
Review in Journal of anesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The optimal central venous catheter (CVC) tip position remains controversial. Shallow placement above the pericardial reflection was recommended to avoid cardiac tamponade, whereas recent practice has favored positioning near the cavo-atrial junction (CAJ) to reduce risks of thrombosis and catheter dysfunction. We compared complications across tip positions: Zone A (CAJ/lower superior vena cava [SVC]/upper right atrium), Zone B (upper SVC), and Zone C (left brachiocephalic vein). We searched MEDLINE, Embase, CENTRAL, Ichushi-Web, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to January 2026. We included randomized and non-randomized studies comparing CVC tip positions in adults. Two reviewers screened studies and assessed risk of bias. Random-effects meta-analyses synthesized adjusted odds ratios (ORs) and crude risk ratios (RRs). Certainty was assessed using GRADE. Fifteen studies (9,589 participants; 9,815 catheters) were included. Compared with Zone B, Zone A probably reduces catheter-related thrombosis in adjusted analyses (OR 0.17; 95% confidence interval [CI] 0.05-0.59) and may reduce thrombosis in crude analyses (RR 0.14; 95% CI 0.03-0.55). Zone A may also reduce the risk of catheter occlusion or dysfunction compared with Zone B (RR 0.44; 95% CI 0.23-0.82). For thrombosis, Zone C may show little-to-no difference compared with Zone B, whereas the comparison between Zones C and A is highly uncertain. Mortality and cardiac tamponade were not estimable. CAJ positioning (Zone A) may lower thrombosis and catheter dysfunction compared with upper SVC positioning (Zone B). Evidence on rare severe complications remains uncertain.
trial registrationPROSPERO (CRD420261292506).
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Registered trials
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