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BJA Advance Access originally published online on January 8, 2007
British Journal of Anaesthesia 2007 98(2):225-227; doi:10.1093/bja/ael339
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Bedside prediction of the central venous catheter insertion depth

H.-G. Ryu, J.-H. Bahk*, J.-T. Kim and J.-H. Lee

Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

* Corresponding author: Department of Anesthesiology, Seoul National University Hospital, 28 Yongon-dong Jongno-gu, Seoul 110-744, Republic of Korea. E-mail: bahkjh{at}snu.ac.kr

BACKGROUND: The carina level has been shown to be near the pericardial reflection and can easily be identified as a landmark on a routine chest radiography. The purpose of this study was to reveal a simple method to predict the adequate central venous catheter (CVC) depth, hereby facilitating safe positioning of the CVC tip.

METHODS: Central venous catheterization was performed via the right internal jugular vein (IJV) or the right subclavian vein (SCV). The CVC was placed at a depth derived by adding the length between the needle insertion point and the clavicular notch and the vertical length between the clavicular notch and the carina on the chest radiograph. The distance between the CVC tip and the carina was measured on the postoperative chest radiograph.

RESULTS: The tip position of 100 CVCs placed via the right IJV was 0.1 (1.1) cm [mean (SD)] below the carina (95% CI: 0.3 cm below carina–0.2 cm above carina) and the tip position of 153 CVCs placed via the right SCV was 0.0 (1.2) cm [mean (SD)] below the carina (95% CI: 0.2 cm below carina–0.2 cm above carina). There were nine outliers (two in IJV group and seven in SCV group).

CONCLUSIONS: When CVCs are inserted to a depth derived by adding the length between the needle insertion point and the clavicular notch and the vertical length between the clavicular notch and the carina, the CVC tip can be reliably placed near the carina level.

Keywords: anatomy, carina; anatomy, jugular vein; anatomy, subclavian vein; equipment, cannula intravascular


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This article has been cited by other articles:


Home page
 Br J AnaesthHome page
M. Farooq, J.-H. Bahk, and J.-T. Kim
Bedside prediction of central venous catheter insertion depth
Br. J. Anaesth., May 1, 2007; 98(5): 695 - 696.
[Full Text] [PDF]

E-letters:

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Bedside prediction of the central venous catheter insertion depth
Muhammad Farooq
British Journal of Anaesthesia, 29 Jan 2007 [Full text]
Bedside prediction of central venous catheter insertion depth
Jae-Hyon Bahk, et al.
British Journal of Anaesthesia, 5 Feb 2007 [Full text]
Bedside prediction of the central venous catheter insertion depth
Johann N Emmanuel
British Journal of Anaesthesia, 26 Feb 2007 [Full text]
Re: Bedside prediction of the central venous catheter insertion depth
raman sikka
British Journal of Anaesthesia, 26 Apr 2007 [Full text]
The clavicular landmark for bedside prediction of the central venous catheter insertion depth
Jae-Hyon Bahk
British Journal of Anaesthesia, 3 May 2007 [Full text]

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