title: The carina is not a landmark for central venous catheter placement in neonates.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan. inagawa@med.yokohama-cu.ac.jp
authors.forename: Gaku
authors.initials: G
authors.lastname: Inagawa
authors.forename: Koui
authors.initials: K
authors.lastname: Ka
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kato
authors.forename: Mio
authors.initials: M
authors.lastname: Tanaka
authors.forename: Takaaki
authors.initials: T
authors.lastname: Miwa
authors.forename: Naoto
authors.initials: N
authors.lastname: Morimura
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Koyama
authors.forename: Koichi
authors.initials: K
authors.lastname: Hiroki
mesh_terms: 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*