Depth of central venous catheterization: An audit of practice in a cardiac surgical unit

J. S. Rutherford, A. F. Merry, C. J. Occleshaw

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


Central venous catheter (CVC) depth relative to the cephalic limit of the pericardial reflection (CLPR) was assessed retrospectively in 100 adult patients from chest radiographs taken after admission to the intensive care unit. A well known landmark proved to be considerably influenced by parallax; therefore we located the CLPR by a new landmark, the junction of the azygos vein and the superior vena cava, identified by the angle of the right main bronchus and the trachea. The majority (58) of CVC tips lay below the pericardial reflection on the first chest radiograph (CXR). Of these only two had been corrected by the time of the next routine CXR. No case of cardiac tamponade secondary to erosion by a CVC could be remembered, or identified from records of routine departmental audit meetings, for the last ten years. Nevertheless, reported incidents of this complication have often been fatal and vigilance is necessary in any patient with a CVC.

Original languageEnglish (US)
Pages (from-to)267-271
Number of pages5
JournalAnaesthesia and Intensive Care
Issue number3
StatePublished - 1994


  • Cardiac tamponade
  • Central venous catheter
  • Central venous catheterization
  • Complications
  • Equipment
  • Pericardial

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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