title: Comparison of radiographic landmarks and the echocardiographic SVC/RA junction in the positioning of long-term central venous catheters.
abstract: BACKGROUND
  When implanting a permanent central venous catheter, the usual aim is to place the tip at the superior vena cava/right atrial (SVC/RA) junction. However, data validating radiographic landmarks of the SVC/RA junction are limited. This investigation was undertaken to compare the radiographic landmarks with the SVC/RA junction as determined by transesophageal echocardiography (TEE).
  
  
  METHODS
  In 20 adult oncologic patients undergoing implantation of a permanent subcutaneous central venous catheter, the catheter tip was placed in the SVC/RA junction under TEE guidance. The position of the catheter tip on chest X-ray, which represented the echocardiographic SVC/RA junction, was then compared with a standard radiographic landmark of the SVC/RA junction and with thoracic vertebral levels.
  
  
  RESULTS
  In all but two patients radiographic SVC/RA junctions were identified. The echocardiographic SVC/RA junction ranged from 0.6 cm above to 2.8 cm below the radiographic SVC/RA junction. There was a significant difference between the distance from the carina to the radiographic SVC/RA junction and the distance from the carina to the echocardiographic SVC/RA junction. The thoracic vertebral body correlating with the echocardiographic SVC/RA junction ranged from the sixth to the ninth level.
  
  
  CONCLUSIONS
  Both the radiographic SVC/RA junction and the thoracic vertebral bodies are not reliable landmarks for the SVC/RA junction defined by TEE. Physicians should be aware that using the radiographic SVC/RA junction to confirm proper positioning of permanent central venous catheters risks placing the catheter tip in the upper SVC, with subsequent potential long-term complications. More reliable radiographic landmarks for the SVC/RA junction should be investigated.
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: J-H
authors.initials: JH
authors.lastname: Hsu
authors.forename: C-K
authors.initials: CK
authors.lastname: Wang
authors.forename: K-S
authors.initials: KS
authors.lastname: Chu
authors.forename: K-I
authors.initials: KI
authors.lastname: Cheng
authors.forename: H-Y
authors.initials: HY
authors.lastname: Chuang
authors.forename: T-S
authors.initials: TS
authors.lastname: Jaw
authors.forename: J-R
authors.initials: JR
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous; D017548:Echocardiography, Transesophageal; D005260:Female; D006321:Heart / Q000033:anatomy & histology*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*