Estimation of catheter insertion depth during ultrasound-guided subclavian venous catheterization

Shin, Hyun-Jung; Kim, Byung; Na, Hyo-Seok; Oh, Ah-Young; Park, Hee-Pyoung; Jeon, Young-Tae
October 2015
Journal of Anesthesia;Oct2015, Vol. 29 Issue 5, p724
Academic Journal
Background: Several methods have been used to predict the optimal depth of central venous catheter (CVC) tip position when using the anatomical landmark technique. In the present study, we devised a simple formula to predict CVC depth using ultrasound images and chest X-ray (CXR) in patients undergoing ultrasound-guided subclavian venous catheterization. Methods: Central venous catheterization via the subclavian vein was performed under ultrasound guidance. We measured five parameters to determine the distance between the needle insertion point and the CVC tip: insertion point to vein puncture point ( A), insertion point to a skin point indicating a vertical position above the vein puncture point ( B), insertion point to the clavicular notch ( C), clavicular notch to the carina ( D), and catheter tip to carina ( E). Catheter insertion depth was then determined as follows: calculated catheter insertion depth = A − B + C + D; actual catheter insertion depth = ( A − B + C + D) + E. Results: The calculated CVC insertion depth (mean ± SD) was 15.4 ± 1.5 cm from the needle insertion point to the carina [95 % confidence interval (CI) 15.0-15.9 cm]. Actual depth was 15.4 ± 1.5 cm (95 % CI 15.0-15.9 cm). No significant difference was observed between the calculated CVC insertion depth and the actual distance from the needle insertion point to the carina ( p = 0.940). Conclusions: The appropriate length of a CVC inserted through the subclavian vein can be estimated by a formula using ultrasound images and CXR.


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