MRI of Central Venous Anatomy

Aslamy, Zaki; Dewald, Christian L.; Heffner, John E.

doi:10.1378/chest.114.3.820

Cited by 141 publications

(26 citation statements)

References 18 publications

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“…The tip of a central venous catheter is recommended to be positioned in the SVC and outside the pericardial sac to prevent serious complications such as cardiac tamponade. As the pericardial reflection is as high as 2 cm above the SVC-RA junction [17], the optimal depth of the central venous catheter is 2–3 cm above the SVC-RA junction. Our study showed that the carina level was always at least 2 cm above the SVC-RA junction in all studied patients, indicating the valuable role of the carina as a landmark on chest radiography.…”

Section: Discussionmentioning

confidence: 99%

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

et al. 2017

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BackgroundThe determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae.MethodsThe patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon’s direct inspection in the surgical field was performed. The range −1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction.ResultsA total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon’s inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05–0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients.ConclusionsPreoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter.Trial registrationThis study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477).Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0347-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

et al. 2017

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“…Routine chest radiography after CVC insertion has been considered the gold standard for detecting catheter location; however, this is usually done after the patient is transferred to the ICU. The presence of various radiographic landmarks allows the radiologist to ensure the correct positioning of catheter tips (11, 20-23). According to our findings, detecting catheter misplacement in a real-time fashion can prevent related possible complications in at least two thirds of patients.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

et al. 2016

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BackgroundChest radiography after central venous catheter (CVC) insertion is the main method of verifying the catheter location. Despite the widespread use of radiography for detecting catheter position, x-ray may not always be readily available, especially in the operating room.ObjectivesWe aimed to compare contrast-enhanced ultrasonography (CEUS) and chest radiography for detecting the correct location of CVCs.MethodsOne hundred sixteen consecutive patients with indications for CVC before cardiac surgery were enrolled in this observational study. After catheter insertion, CEUS was performed. Portable radiography was obtained postoperatively in the intensive care unit. Sensitivity, specificity, and predictive values were determined by comparing the ultrasonography results with radiographic findings as a reference standard.ResultsChest radiography revealed 16 CVC misplacements: two cases of intravascular and 14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter malpositionings in the RA, while it could not recognize seven catheter placements correctly. CEUS showed two false RA misplacements and five falsely correct CVC positions. A sensitivity of 98% and specificity of 69% were achieved for CEUS in detecting CVC misplacements. Positive and negative predictive values were 95% and 85%, respectively. The interrater agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001).ConclusionsDespite close concordance between ultrasonography and chest radiography, CEUS is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored.

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“…The present authors consider distal intrathoracic and atrial locations to also represent malpositions, and thus the data of Pikwer et al may under-represent the incidence. An appropriate radiographic landmark to guide appropriate catheter tip position on chest x-ray is the right tracheobronchial angle, which is always inferior to the cephalad origin of the superior vena cava by a median distance of 1.5 cm; this landmark is always at least 2.9 cm superior to the atriocaval junction 11. Thus, catheter tips positioned approximately 3 cm below the right tracheobronchial angle will lie in close proximity to the atriocaval junction but will remain extracardiac in location (Figure 1).…”

Section: General Considerationsmentioning

confidence: 99%

Anatomic considerations for central venous cannulation

Bannon

Heller²,

Rivera³

2011

RMHP

125

139

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Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed.

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MRI of Central Venous Anatomy

Cited by 141 publications

References 18 publications

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

Anatomic considerations for central venous cannulation

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