title: Usefulness of the carina as a radiographic landmark for central venous catheter placement in paediatric patients.
abstract: 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.
authors.affiliation: Department of Anaesthesiology, College of Medicine, Seoul National University, Korea.
authors.forename: S Z
authors.initials: SZ
authors.lastname: Yoon
authors.forename: J H
authors.initials: JH
authors.lastname: Shin
authors.forename: S
authors.initials: S
authors.lastname: Hahn
authors.forename: A Y
authors.initials: AY
authors.lastname: Oh
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: S D
authors.initials: SD
authors.lastname: Kim
authors.forename: C S
authors.initials: CS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000886:Anthropometry / Q000379:methods; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods; D007601:Jugular Veins; D011859:Radiography; D011873:Radiology Information Systems; D014132:Trachea / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014683:Vena Cava, Superior / Q000033:anatomy & histology / Q000000981:diagnostic imaging