Correct Depth of Insertion of Right Internal Jugular Central Venous Catheters Based on External Landmarks

Avoiding the Right Atrium

Tiberiu Ezri, Marian Weisenberg, Daniel I. Sessler, Haim Berkenstadt, Sorin Elias, Peter Szmuk, Francis Serour, Shmuel Evron

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective: Radiographically, a central venous catheter (CVC) tip should lie at the level of the right tracheobronchial angle. Precalculation of length of CVC insertion may avoid unnecessary catheter malposition. The purpose of this study was to assess the accuracy of a method of CVC positioning, based on external topographic landmarks. Design: A prospective, randomized study.:. Setting: University-affiliated hospital, single institution. Participants: Patients scheduled for surgery. Interventions: Patients were allocated for insertion of the catheter through the right internal jugular vein to either a fixed, predetermined, 15-cm length (n = 50) or to a depth calculated topographically (n = 50) by drawing a line from the level of the thyroid notch to the sternal manubrium. The catheter was repositioned if its tip was situated >5 cm above the carina or >1 cm below it. The distance from the catheter tip to the carina was measured. The main study endpoint was the need for catheter repositioning. Measurements and Main Results: Two percent of patients required repositioning in the topographic group compared with 78% in the 15-cm length group (p < 0.001). No patient in the topographic group and 10 patients (20%) in the 15-cm group had the catheter placed in the right atrium (p < 0.05). The mean distance from the CVC tip to the carina was 2.9 ± 1.4 cm above the carina in the topographic group and 1.9 ± 1.1 cm below the carina in the 15-cm length group (p < 0.001). No patient had a too proximally placed catheter. Insertion lengths in the topographic group ranged between 9 and 12.5 cm. Conclusions: It is recommended to use the topographic approach in deciding CVC depth with right internal jugular CVC placement.

Original languageEnglish (US)
Pages (from-to)497-501
Number of pages5
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume21
Issue number4
DOIs
StatePublished - Aug 2007

Fingerprint

Central Venous Catheters
Heart Atria
Neck
Catheters
Manubrium
Moving and Lifting Patients
Jugular Veins
Thyroid Gland
Prospective Studies

Keywords

  • cardiac tamponade
  • central venous catheterization
  • central venous catheters
  • complications
  • internal jugular vein
  • methods of positioning
  • topographic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Correct Depth of Insertion of Right Internal Jugular Central Venous Catheters Based on External Landmarks : Avoiding the Right Atrium. / Ezri, Tiberiu; Weisenberg, Marian; Sessler, Daniel I.; Berkenstadt, Haim; Elias, Sorin; Szmuk, Peter; Serour, Francis; Evron, Shmuel.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 21, No. 4, 08.2007, p. 497-501.

Research output: Contribution to journalArticle

Ezri, Tiberiu ; Weisenberg, Marian ; Sessler, Daniel I. ; Berkenstadt, Haim ; Elias, Sorin ; Szmuk, Peter ; Serour, Francis ; Evron, Shmuel. / Correct Depth of Insertion of Right Internal Jugular Central Venous Catheters Based on External Landmarks : Avoiding the Right Atrium. In: Journal of Cardiothoracic and Vascular Anesthesia. 2007 ; Vol. 21, No. 4. pp. 497-501.
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abstract = "Objective: Radiographically, a central venous catheter (CVC) tip should lie at the level of the right tracheobronchial angle. Precalculation of length of CVC insertion may avoid unnecessary catheter malposition. The purpose of this study was to assess the accuracy of a method of CVC positioning, based on external topographic landmarks. Design: A prospective, randomized study.:. Setting: University-affiliated hospital, single institution. Participants: Patients scheduled for surgery. Interventions: Patients were allocated for insertion of the catheter through the right internal jugular vein to either a fixed, predetermined, 15-cm length (n = 50) or to a depth calculated topographically (n = 50) by drawing a line from the level of the thyroid notch to the sternal manubrium. The catheter was repositioned if its tip was situated >5 cm above the carina or >1 cm below it. The distance from the catheter tip to the carina was measured. The main study endpoint was the need for catheter repositioning. Measurements and Main Results: Two percent of patients required repositioning in the topographic group compared with 78{\%} in the 15-cm length group (p < 0.001). No patient in the topographic group and 10 patients (20{\%}) in the 15-cm group had the catheter placed in the right atrium (p < 0.05). The mean distance from the CVC tip to the carina was 2.9 ± 1.4 cm above the carina in the topographic group and 1.9 ± 1.1 cm below the carina in the 15-cm length group (p < 0.001). No patient had a too proximally placed catheter. Insertion lengths in the topographic group ranged between 9 and 12.5 cm. Conclusions: It is recommended to use the topographic approach in deciding CVC depth with right internal jugular CVC placement.",
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AU - Weisenberg, Marian

AU - Sessler, Daniel I.

AU - Berkenstadt, Haim

AU - Elias, Sorin

AU - Szmuk, Peter

AU - Serour, Francis

AU - Evron, Shmuel

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KW - complications

KW - internal jugular vein

KW - methods of positioning

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