title: Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients.
abstract: BACKGROUND
  Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.
  
  
  METHODS
  Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as 'Point I'. The sternal head of the right clavicle was called 'Point A' and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called 'Point B'. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.
  
  
  RESULTS
  The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients' age, height, and weight.
  
  
  CONCLUSIONS
  The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Na
authors.forename: J T
authors.initials: JT
authors.lastname: Kim
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Bahk
authors.forename: C S
authors.initials: CS
authors.lastname: Kim
authors.forename: S D
authors.initials: SD
authors.lastname: Kim
mesh_terms: D000886:Anthropometry / Q000379:methods*; D001827:Body Height; D001835:Body Weight; D002405:Catheterization, Central Venous / Q000379:methods*; D002675:Child, Preschool; D002968:Clavicle / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000033:anatomy & histology; D009558:Nipples / Q000033:anatomy & histology; D019990:Perioperative Care / Q000379:methods; D011859:Radiography; D014132:Trachea / Q000033:anatomy & histology / Q000000981:diagnostic imaging