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BJA Advance Access originally published online on July 22, 2005
British Journal of Anaesthesia 2005 95(4):514-517; doi:10.1093/bja/aei199
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org

Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients{dagger}

S. Z. Yoon, J. H. Shin, S. Hahn1, A. Y. Oh, H. S. Kim, S. D. Kim and C. S. Kim*

Department of Anaesthesiology, College of Medicine, Seoul National University, Seoul, Korea. 1 Medical Research Collaborating Centre, College of Medicine, Seoul National University, Seoul, Korea

* Corresponding author. E-mail: monday1031{at}yahoo.co.kr

Background. Several reports have proposed radiographic landmarks for the proper positioning of central venous catheters (CVC). The carina is one of the proposed landmarks in adults. Here, we evaluate the possibility of using the carina as a radiographic landmark for the identification of proper positioning of the CVC tip in paediatric patients.

Methods. We studied 57 right internal jugular vein catheterizations in infants and children undergoing surgery for the treatment of congenital heart disease. After placing the CVC tip at the junction of the superior vena cava and the right atrium (SVC–RA junction) via intraoperative transoesophageal echocardiography, and by taking postoperative anterior–posterior chest radiographs, we measured the longitudinal distance from the carina to the SVC–RA junction, using the Picture Archiving and Communicating System.

Results. The average distance between the carina and the SVC–RA junction was 1.5 cm (95% CI 1.3–1.8 cm). No catheter tip was above the carina. Although there was no particular relationship between this distance and the patient's age, height, or weight, the distance between the carina and the SVC–RA junction tended to be more variable in younger and smaller children.

Conclusions. The carina can be used as a radiographic landmark for the proper CVC tip placement in paediatric patients. If the tip of the CVC is not distal to the carina the chances are minute that it is in the right atrium.

{dagger} Presented, in part, at the 2005 Annual Meeting of European Society of Anaesthesiologists, Vienna, Austria.


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This article has been cited by other articles:


Home page
 Br J AnaesthHome page
P. A. Stonelake and A. R. Bodenham
The carina as a radiological landmark for central venous catheter tip position
Br. J. Anaesth., March 1, 2006; 96(3): 335 - 340.
[Abstract] [Full Text] [PDF]

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Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediat
Baljit Singh, et al.
British Journal of Anaesthesia, 3 Mar 2006 [Full text]
Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediat
Seung Z. Yoon, et al.
British Journal of Anaesthesia, 14 Mar 2006 [Full text]

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