How correct is the correct length for central venous catheter insertion

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.

Assessment of the Tip Position of Central Venous Catheters Inserted Using Peres' Height Formula

OBJECTIVES

The tip of a central venous catheter (CVC) should be positioned in the proximity of the cavo-atrial junction (CAJ) where the lower third of the superior vena cava (SVC) and the upper right atrium (RA) are located to prevent life-threatening complications. This study aimed to determine the accuracy of Peres' height formula in predicting the correct insertion depth of CVC.  Methods: A total of 332 patients were enrolled in this prospective observational study. All CVCs were inserted using Peres' formula. The 'correct' tip position of CVC was the placement of the CVC tip 1 cm above and 1 cm below the carina in CXR. Rates of correct placements for each side and site of catheter insertions, gender, and body mass index (BMI) differences were evaluated.

RESULTS

The correct placement rate of all catheters was 74.4%. There were statistically significant correlations between the correct placement of right-sided jugular and subclavian catheters (p<0.001) and left-sided jugular and subclavian catheters (p=0.014). There was a statistically significant difference in male patients (p=0.047). Higher BMI resulted in a lower rate of correct placement with no statistically significant difference (p=0.457).

CONCLUSIONS

Peres' formula can be easily used to determine the correct position of CVC tips with a success rate in the Turkish population. However, practitioners should be aware of the low accuracy rate of Peres' formula in female patients (68.5%) and patients with BMI over 35 kg/m² (62.5%).

Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study

Objective

Central venous cannulation of the internal jugular vein is difficult in paediatric patients because of the small size of the vein and anatomic variations. Many studies have shown the accuracy of various formulae for calculating the depth of placement. The aim of this study was to assess the most reliable method for central venous catheter (CVC) tip placement in paediatric patients.

Methods

Sixty-nine patients in the age groups from 0 to 12 years were divided in three groups for three published techniques for catheter tip placement. In Group E, catheter tip was placed at the distance measured from entry point to sternal angle. In Groups P and H, Peres and trans-oesophageal echocardiography (TEE)-derived formulae, respectively, were used for catheter placement. Post-procedure chest radiograph was performed for all patients, and tip position was recorded. Appropriate catheter tip position was considered just above or at the level of carina. The number of attempts and complications were recorded. Chi-square test was used for statistical analysis.

Results

Of 69 patients, 65% of patients in Group P, 52% in group H and 91% in group E had appropriate CVC tip placement. The chi-square test showed that the difference in the number of patients with appropriately positioned CVC tip among the three groups was statistically significant (p=0.0134), with intergroup analysis showing Group E to be superior. One patient had an episode of arrhythmia during guide wire insertion and was resuscitated successfully.

Conclusion

Catheter tip placement by external distance or landmark technique is a more accurate method for catheter placement than the Peres and TEE-based formulae. It does not require measurement of patients' height and reduces the chances of repositioning of catheter.

Optimum depth of central venous catheter - Comparision by pere's, landmark and endocavitory (atrial) ECG technique: A prospective study

Context:

Blind insertion of central venous catheter has many implications. Better options should be sought to perform this procedure.

Aim:

To evaluate various options for positioning central venous catheter tip.

Settings and Design:

This is institutional based randomized prospective controlled study.

Materials and Methods:

In this prospective study depth and position of central venous catheter were evaluated in 150 patients in intensive care unit. Three different methods: Pere's, landmark, and endocavitory (atrial) ECG control were used.

Statistical Analysis:

Twoway ANOVA test was applied on SPSS version 16 to test the significant difference between the three groups.

Results:

Patient characteristic and demographic data were similar in the three groups. The average depth of central venous catheter by Pere's, landmark, and endocavitory (ECG) technique were 14.20 ± 0.69 cm, 12.08 ± 0.98 cm, and 8.18 ± 0.74 cm, respectively.

Conclusion:

The correct position of central venous catheter by endocavitory (atrial) ECG appears not only to reduce the procedure related complications but also post procedure manipulation of catheter tip detected by post procedure chest X-ray.

Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location.

Optimal position of a long-term central venous catheter tip in a pediatric patient with congenital diseases

Progress in medical and scientific research has increased the chances of survival for young patients with congenital diseases, children who, in the past, would not have had any chance of survival. Nowadays, congenital diseases can be treated with appropriate replacement therapies. These treatments can be difficult to administer in young patients because of the high frequency of administration (sometimes more than a dose per week), the use of intravenous infusion and the long-term or life-term requirement.

Endovascular electrocardiography to guide placement of totally implantable central venous catheters in oncologic patients

PURPOSE

Appropriate tip position of totally implantable central venous catheters is essential in order to prevent catheter-related complications, in particular thrombosis. Endovascular electrocardiography is an economic and safe method to guide placement of catheters into the central veins. Although widely utilized, there is still lack of conclusive evidence about its efficacy. The aim of the study was to assess the efficacy and safety of endovascular electrocardiographic guided placement compared to the anthropometric method.

METHODS

Endovascular ECG was employed to guide electrocardiographic placement of a central venous catheter in a cohort of oncologic patients. The rate of correct placement and the incidence of catheter-related thrombosis were considered. Patients in which central venous catheters were inserted with the anthropometric technique were considered as control group.

RESULTS

The rate of correct placement was 91% and 50% for ECG-guided and anthropometric catheters (p<0.0001) respectively. None of the patients suffered from early insertion-related complications. The rate of catheter-related vascular thrombosis was lower for ECG-guided catheters (3.6% vs. 9.6%, n.s.), in particular for left-inserted catheters (0% vs. 33.3%, p=0.02).

CONCLUSION

Endovascular electrocardiography was more effective than the anthropometric technique in placement of implantable central venous catheters and was associated with a lower incidence of catheter-related thrombosis, in particular for those inserted from the left-side.