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BJA Advance Access originally published online on April 19, 2009
British Journal of Anaesthesia 2009 102(6):820-823; doi:10.1093/bja/aep078
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients

H. S. Na1, J. T. Kim2,*, H. S. Kim2, J. H. Bahk2, C. S. Kim2 and S. D. Kim2

1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
2 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehakno, Jongnogu, Seoul 110-744, Republic of Korea

* Corresponding author. E-mail: kimjintae73{at}dreamwiz.com

Background: Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.

Methods: Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as ‘Point I’. The sternal head of the right clavicle was called ‘Point A’ and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called ‘Point B’. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.

Results: The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina–0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients’ age, height, and weight.

Conclusions: The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.

Keywords: anaesthesia, paediatric; anatomy, jugular vein; veins, jugular, canulation


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