Depth of central venous catheterization: an audit of practice in a cardiac surgical unit.
Central venous catheter (CVC) depth relative to the cephalic limit of the pericardial reflection (CLPR) was assessed retrospectively in 100 adult patients from chest radiographs taken after admission to the intensive care unit. A well known landmark proved to be considerably influenced by parallax; therefore we located the CLPR by a new landmark, the junction of the azygos vein and the superior vena cava, identified by the angle of the right main bronchus and the trachea. The majority (58) of CVC tips lay below the pericardial reflection on the first chest radiograph (CXR). Of these only two had been corrected by the time of the next routine CXR. No case of cardiac tamponade secondary to erosion by a CVC could be remembered, or identified from records of routine departmental audit meetings, for the last ten years. Nevertheless, reported incidents of this complication have often been fatal and vigilance is necessary in any patient with a CVC.
Rutherford
J S
JS
Green Lane Hospital, Auckland, New Zealand.
Merry
A F
AF
Occleshaw
C J
CJ
D000293:Adolescent; D000328:Adult; D000776:Anesthesiology; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001424:Bacterial Infections; D016121:Brachiocephalic Veins / Q000293:injuries; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006341:Heart Rupture / Q000209:etiology; D006352:Heart Ventricles / Q000293:injuries; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008485:Medical Audit; D013902:Radiography, Thoracic; D013927:Thrombosis / Q000209:etiology; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging