The carina is not a landmark for central venous catheter placement in neonates.
BACKGROUND
Cardiac tamponade is rare but one of the most serious complications in relation to central venous catheters (CVC). The tip of the CVC should be placed outside the pericardium to avoid tamponade. In adults, the carina is always located above the pericardium; therefore, the carina is a reliable landmark for CVC placement. We examined whether the carina could also be an adequate landmark for CVC placement in neonates.


METHODS
The study was conducted using nine fresh neonatal cadavers. The longitudinal distance between the carina and the pericardium as it transverses the superior vena cava (the pericardial reflection: PR) was measured.


RESULTS
The median postconceptional age (gestational age in weeks + weeks after delivery) at autopsy was 35 (range: 23-42) weeks. The PR was located at a distance of 4 mm above to 5 mm below the carina. Unlike in adults, the position of the PR varies in relation to the carina in neonates. In seven of the nine subjects, the location of the PR was above the carina.


CONCLUSIONS
In neonates, the carina is not always located above the pericardium, as it is in adults; therefore, the carina is not an appropriate landmark for CVC placement.
Inagawa
Gaku
G
Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan. inagawa@med.yokohama-cu.ac.jp
Ka
Koui
K
Tanaka
Yukichi
Y
Kato
Keisuke
K
Tanaka
Mio
M
Miwa
Takaaki
T
Morimura
Naoto
N
Koyama
Yukihide
Y
Hiroki
Koichi
K
D000328:Adult; D001837:Body Weights and Measures / Q000379:methods; D002102:Cadaver; D002305:Cardiac Tamponade / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D010496:Pericardium / Q000033:anatomy & histology; D014132:Trachea / Q000033:anatomy & histology*; D014683:Vena Cava, Superior / Q000033:anatomy & histology*