Correct depth of insertion of right internal jugular central venous catheters based on external landmarks: avoiding the right atrium.
OBJECTIVE
Radiographically, a central venous catheter (CVC) tip should lie at the level of the right tracheobronchial angle. Precalculation of length of CVC insertion may avoid unnecessary catheter malposition. The purpose of this study was to assess the accuracy of a method of CVC positioning, based on external topographic landmarks.


METHODS
A prospective, randomized study.


METHODS
University-affiliated hospital, single institution.


METHODS
Patients scheduled for surgery.


METHODS
Patients were allocated for insertion of the catheter through the right internal jugular vein to either a fixed, predetermined, 15-cm length (n = 50) or to a depth calculated topographically (n = 50) by drawing a line from the level of the thyroid notch to the sternal manubrium. The catheter was repositioned if its tip was situated >5 cm above the carina or >1 cm below it. The distance from the catheter tip to the carina was measured. The main study endpoint was the need for catheter repositioning.


RESULTS
Two percent of patients required repositioning in the topographic group compared with 78% in the 15-cm length group (p < 0.001). No patient in the topographic group and 10 patients (20%) in the 15-cm group had the catheter placed in the right atrium (p < 0.05). The mean distance from the CVC tip to the carina was 2.9 +/- 1.4 cm above the carina in the topographic group and 1.9 +/- 1.1 cm below the carina in the 15-cm length group (p < 0.001). No patient had a too proximally placed catheter. Insertion lengths in the topographic group ranged between 9 and 12.5 cm.


CONCLUSIONS
It is recommended to use the topographic approach in deciding CVC depth with right internal jugular CVC placement.
Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel.
Tiberiu
T
Ezri
Marian
M
Weisenberg
Daniel I
DI
Sessler
Haim
H
Berkenstadt
Sorin
S
Elias
Peter
P
Szmuk
Francis
F
Serour
Shmuel
S
Evron
D000368:Aged; D000886:Anthropometry / Q000379:methods*; D002305:Cardiac Tamponade / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D007601:Jugular Veins; D008297:Male; D009333:Neck / Q000033:anatomy & histology*; D019990:Perioperative Care / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D013249:Sternum / Q000033:anatomy & histology*