| Survey of Central Venous Catheter Depth Using the Carina as a Radiologic Landmark in ICU Patients. |
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Jin Huh, Seung Yeon Yoo, Young Jin Ro, Seong Won Min, Jae Hyon Bahk, Jong Su Kim |
1Department of Anesthesiology and Pain Medicine, Boramae Municipal Hospital, Seoul, Korea. amandla@empal.com
2Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
There is no unique guideline as to how to determine the depth of a central venous catheter (CVC). In this study, we inspected the current practice of CVC placement and evaluated insertion depth using the carina as a radiologic landmark in intensive care unit (ICU) patients.
METHODS
In 138 ICU patients with a CVC in the right subclavian (SCV group) or internal jugular vein (IJV group), a chest X ray was taken, and the radiographic vertical distance between the catheter tip and the carina level (D-CC) was measured in Picture Archiving and Communication System (PACS) view. The distance between the skin puncture site and the carina level (D-SC) was calculated by adding/subtracting D-CC to/from the actual CVC insertion length. In addition, we surveyed physicians using a questionnaire about the methods they used to determine CVC depth.
RESULTS
Mean D-SC was 13.80 +/- 1.69 cm in the SCV group, 14.42 +/- 1.34 cm in the IJV group, but no correlation was found with any measured physical dimension. In males, D-SC was greater, but this difference was not statistically significant. Physicians determined required insertion depths using many different methods (e.g., height, sex......).
CONCLUSIONS
Patient height, weight, body mass index (BMI), and sex were not found to be reliable for predicting a safe CVC length. We recommend that after CVC insertion, a chest X ray should be taken and the catheter tip repositioned if necessary to reduce catheter related fatal complications (e.g., cardiac tamponade). |
| Key Words:
carina; central venous catheter; chest X ray; internal jugular vein; PACS; subclavian vein |
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