title: Simple formulas to determine optimal subclavian central venous catheter tip placement in infants and children.
abstract: OBJECTIVE
  Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children.
  
  
  METHODS
  We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA).
  
  
  RESULTS
  Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5 BSA+7 cm, and for the right subclavian vein approach it was 5 BSA+6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children.
  
  
  CONCLUSIONS
  The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center and the University of Massachusetts School of Medicine; Department of Surgery, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School.
authors: Andrea
authors: A
authors: Stroud
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center and the University of Massachusetts School of Medicine; Boston Children's Hospital and Harvard Medical School.
authors: Jill
authors: J
authors: Zalieckas
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center and the University of Massachusetts School of Medicine; Boston Children's Hospital.
authors: Corinne
authors: C
authors: Tan
authors: Boston Children's Hospital and the University of Massachusetts School of Medicine; University of Massachusetts School of Medicine.
authors: Sarah
authors: S
authors: Tracy
authors: Boston Children's Hospital and the University of Massachusetts School of Medicine; Boston Children's Hospital.
authors: David
authors: D
authors: Zurakowski
authors: Department of Surgery, Dartmouth-Hitchcock Medical Center and the University of Massachusetts School of Medicine; Boston Children's Hospital and Harvard Medical School. Electronic address: David.mooney@childrens.harvard.edu.
authors: David P
authors: DP
authors: Mooney
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D001835:Body Weight; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D055641:Mathematical Concepts; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Central venous catheter; Complication; Pediatric; Subclavian vein; Technique