title: The mid-sternal length, a practical anatomical landmark for optimal positioning of long-term central venous catheters.
abstract: BACKGROUND
  Long-term tunneled catheters are used for the hemodialysis or chemotherapy in many patients. Proper placement of the catheter tip could reduce early and late catheter related complications. Aim of the present study was to evaluate a new formula for proper placement of tunneled hemodialysis or infusion port device by using an external anatomic landmark.
  
  
  METHODS
  A total of 64 adult patients undergoing elective placement of tunneled Central Venous Catheter (CVC) requiring hemodialysis or chemotherapy were enrolled in this prospective study during 2011-2012 in the university hospital. The catheter length to be inserted in the right internal jugular vein (IJV) was calculated by adding two measurements (the shortest straight length between the insertion point of the needle and the suprasternal notch plus and half of sternal length). The catheter position was considered correct if the tip was positioned in the right atrium (RA) or Superior vena cava (SVC)-RA junction.
  
  
  RESULTS
  The patients were 55.28 ± 19.85 years of age, weighed 5.78 ± 16.62 kg and were 166.07 ± 10.27 cm tall. Catheters were inserted successfully in 88% of patients (n = 56). Catheter tip positions in the failures were SVC (n = 5), tricuspid valve (n = 2), and right ventricle (n = 1) in our patients.
  
  
  CONCLUSIONS
  Long-term hemodialysis or port CVC could easily insert in the right IJV by using half of the sternal length as an external land marks among adult patients.
authors.affiliation: Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Fereshte
authors.initials: F
authors.lastname: Salimi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Imani
authors.forename: Navab
authors.initials: N
authors.lastname: Ghasemi
authors.forename: Amir
authors.initials: A
authors.lastname: Keshavarzian
authors.forename: Amir Hosein Davarpanah
authors.initials: AH
authors.lastname: Jazi
keywords: External landmark; hemodialysis; port device