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Appropriate Length of the Central Venous Catheter Insertion via Right Internal Jugular Vein in Children Using External Anatomical.

A CVC (central venous catheter) is used to measure Central venous pressure and also to administer drugs. The direct measurement of the estimated insertion length using the puncture site and the external landmark could be more practical and bedside. Here we use sternal head of right clavicle and nipple as landmarks for inserting the CVC (central venous catheter) tip near the svc (superior vena cava) and right atrial junction. Objectives of the Study: To Evaluate a method for cvp insertion depth using anatomical landmark

Materials and Methods: A study in PICU, KIMS (kempegowda institute of medical sciences) from Oct 13-14. 35 patients were enrolled irrespective of age. Point A marked at the sternal head of the right clavicle, A horizontal line drawn connecting the nipple on both sides, and then the midpoint of the perpendicular line drawn between Point A and the horizontal line was designated as Point B. The distance between the insertion point of the needle (I) and Point A is measured and the distance between Points A and B was also measured. Insertion depth was determined by adding the two and subtracting 0.5 cm from this. Presence of CVC tip in right atrium and svc junction was confirmed using 2D Echo (echo cardiography) and X-ray chest.

Results: Out of the 35 cases studied in 32 cases cvc was exactly placed at the level of carina (91.4%) and in 3 cases the tip was exactly placed at right atrial and svc junction, while in the rest it was deep. On an average with the above formula one could place a cvc 2.9mm SD =/-1.62 mm deep in the right atrium.

Conclusion: It is inferred that this method can be used safely in calculating length of the CVC for right IJV catheterization.

Author(s): Murali BH, Srividya GS, Reshmavathi V