title: The pericardial reflection and the tip of the central venous catheter - topographical analysis in stillborn babies.
abstract: BACKGROUND
  Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium.
  
  
  OBJECTIVE
  To investigate the level of the superior pericardial reflection in stillborn babies.
  
  
  METHODS
  We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25-43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium.
  
  
  RESULTS
  Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5).
  
  
  CONCLUSIONS
  The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space.
authors.affiliation: Department of Pediatric Critical Care Medicine and Neonatology, University Children's Hospital, Kerpener Strasse 62, 50926, Cologne, Germany. Frank.Eifinger@uk-koeln.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Eifinger
authors.affiliation: Department of Pediatric Critical Care Medicine and Neonatology, University Children's Hospital, Kerpener Strasse 62, 50926, Cologne, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Vierzig
authors.affiliation: Department of Pediatric Critical Care Medicine and Neonatology, University Children's Hospital, Kerpener Strasse 62, 50926, Cologne, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Roth
authors.affiliation: Institute of Anatomy II, University of Cologne, Kerpener Strasse 62, 50926, Cologne, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scaal
authors.affiliation: Department of Radiology, University of Cologne, Kerpener Strasse 62, 50926, Cologne, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Koerber
mesh_terms: D002102:Cadaver; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging* / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003287:Contrast Media; D004210:Dissection; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D008297:Male
chemical_list: D003287:Contrast Media
keywords: Central venous catheter; Complications; Foetus; Neonate; Pericardium; Radiography; Right atrium; Stillbirth; Superior vena cava