Review Reports

Round 1

Reviewer 1 Report

Overall, well-written study with high relevance to radiologists, and other healthcare providers, as central catheters are very commonly used in hospitals. The factors researched in this study in association with catheter migration are not novel, but it is highly useful to know that left sided catheters are associated with a higher risk of migration, and thus complications.

Background – the statistics provided about the frequency of central catheters delineated the importance of preventing catheter dysfunction; described many of the common indications for central catheter use. I would add that for patients with ESRD for whom AV graft or fistula isn’t feasible due to stenosis of the vasculature, a tunneled central catheter is their only hemodialysis access, and thus, their lifeline. To further describe the magnitude of catheter-associated complications, I recommend commenting on the cost to the healthcare system in treating the complications associated with catheter dysfunction and prolonged hospitalization.

Conclusions – provided adequate explanation for the study’s findings based on anatomy and type of catheter material. I would recommend also adding that factors not directly amenable to research such as coughing, forceful flushing of catheters, and vigorous use of the arms may lead to catheter migration.

Author Response

Thank you for reviewing our manuscript. All authors are native english speakers, and we have edited the manuscript to in an effort to correct any grammar or spelling mistakes.

Reviewer 1:

Background –

I would add that for patients with ESRD for whom AV graft or fistula isn’t feasible due to stenosis of the vasculature, a tunneled central catheter is their only hemodialysis access, and thus, their lifeline. – Thank you for the comment, this has been added to the introduction section

To further describe the magnitude of catheter-associated complications, I recommend commenting on the cost to the healthcare system in treating the complications associated with catheter dysfunction and prolonged hospitalization. – Thank you for the comment. An additional citation and discussion of costs related to vascular access complication has been added to the introduction section.

Conclusions –

I would recommend also adding that factors not directly amenable to research such as coughing, forceful flushing of catheters, and vigorous use of the arms may lead to catheter migration. – Thank you for the comment. This was added to the end of the discussion.

 

Reviewer 2 Report

Summary

This paper presents a retrospective study on the correlation between the patient/procedural factors (including age, gender, BMI, catheter laterality, CVC type, etc.) which may influence the central venous catheter (CVC) tip migration and subsequent catheter dysfunction. The motivation of the paper is clear with a detailed discussion on the data, statistical analysis metrics, and results. The connection of the findings in this study and the precedent works is also provided.

Comments:

1. It would be more convincing to explain why the specific factors (such as age, gender, etc.) are used, as the number of procedural factors searched in this study is not big.

2. Due to the limitations discussed in the paper, it remains a question how general the findings included in the paper are, and how they could help future studies. It would be nice to include an extended discussion based on the current version. 

Author Response

Thank you for reviewing our manuscript. All authors are native english speakers, and we have edited the manuscript to in an effort to correct any grammar or spelling mistakes.

Reviewer 2:

1. It would be more convincing to explain why the specific factors (such as age, gender, etc.) are used, as the number of procedural factors searched in this study is not big. – Thank you for the comment. Factors were chosen because prior research has proposed BMI, catheter type, gender, catheter laterality all as possible factors related to catheter dysfunction or catheter tip migration. This is now explicitly stated in the discussion section.
2. Due to the limitations discussed in the paper, it remains a question how general the findings included in the paper are, and how they could help future studies. It would be nice to include an extended discussion based on the current version. – Thank you for the comment. We have expanded our discussion section to better explain the relevance of our results, possible areas for future research, and study limitations.

 

Reviewer 3 Report

The paper aims to investigate procedural factors that could influence tip of CVC migration.

The subject matter is very interesting.

However, the article is too concise and some aspects are unclear.

Major revision is required.

• Table 1 is unclear.
• It would be better to insert a figure to explain the type of measurements made.
• The methods section is unclear. How were the measurements made? How accurate are the measurement methods used?
• It would be appropriate to indicate the directions of movement taken into account.
• Does catheter size or influence affect displacement? If so, how has this been considered?

Author Response

Thank you for reviewing our manuscript. All authors are native english speakers, and we have edited the manuscript to in an effort to correct any grammar or spelling mistakes. 

Reviewer 3:

Table 1 is unclear. – We have changed the description of table 1 to better clarify the information.

It would be better to insert a figure to explain the type of measurements made. – Thank for the comment. Figure 1 demonstrates how the measurements were made.

The methods section is unclear. How were the measurements made? How accurate are the measurement methods used? – Thank you for the comment. This was clarified in the Data Collection and Data Items section of the Materials and Methods, and the requested figure was added (figure 1)

It would be appropriate to indicate the directions of movement taken into account. – This was further clarified in the Materials and Methods section under Data Collection and Data Items section, and included in the new figure 1.

Does catheter size or influence affect displacement? If so, how has this been considered? – Analysis comparing large bore tunneled central venous catheters (>9.5 Fr) to all other catheter types showed no increased risk of cranial migration, however

Round 2

Reviewer 3 Report

The article is ready for publication.