Proper Tip Position of Central Venous Catheter in Pediatric Patients

Ahn, Sungyoon; Chung, Jae Hee

doi:10.5301/jva.5000393

Cited by 11 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the carina is not a good landmark for newborns and infants; it has been shown that the catheter tip should be localized at least 0.5 cm for smaller infants (body length: 47e57 cm) and 1 cm for older infants (body length: 58e108 cm) above the carina to ensure that it is outside the pericardial sac [58] (LoE 3). Similarly, it has been shown that the mean distance from the carina to the atriocaval junction was 22.0 ± 9.98 mm [59]. In children beyond infancy the carina can be used as a landmark.…”

Section: Positioning Of the Catheter Tipmentioning

confidence: 90%

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

Braegger¹,

Bronský²,

Cai³

et al. 2018

Clinical Nutrition

View full text Add to dashboard Cite

Section: Positioning Of the Catheter Tipmentioning

confidence: 90%

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

Braegger¹,

Bronský²,

Cai³

et al. 2018

Clinical Nutrition

View full text Add to dashboard Cite

“…The carina in children has been examined in many studies using computed tomography (Ahn and Chung, ), trans‐esophageal echocardiography (Yoon et al, ), and cadavers (Schuster et al, ; Albrecht et al, ; Inagawa et al, ). As in adult studies, pediatric cross‐sectional imaging‐based assessments showed carina–SVC/RA junction distances as great as 3 cm (Yoon et al, ; Ahn and Chung, ). The authors argue that this is still helpful, as in all cases the carina is superior to the SVC/RA junction, therefore it facilitates placement of a CVC in the SVC.…”

Section: Discussionmentioning

confidence: 99%

Defining the surface anatomy of the central venous system in children

et al. 2015

View full text Add to dashboard Cite

Pediatric emergency physicians, pediatric critical care specialists, and pediatric surgeons perform central venous catheterization in many clinical settings. Complications of the procedure are not uncommon and can be fatal. Despite the frequency of application, the evidence-base describing the surface landmarks involved is missing. The aim of the current study was to critically investigate the surface markings of the central venous system in children. The superior vena cava/right atrial (SVC/RA) junction, superior vena cava (SVC) formation, and brachiocephalic vein (BCV) formation were examined independently by two investigators. Three hundred computed tomography (CT) scans collected across multiple centers were categorized by age group into: 0-3 years, 4-7 years, and 8-11 years. Scans with pathology that distorted or obscured the regional anatomy were excluded. The BCV formation was commonly found behind the ipsilateral medial clavicular head throughout childhood. This contrasts with the variable levels of SVC formation, SVC length, and SVC/RA junction. In the youngest group, SVC formation was most commonly at the second costal cartilage (CC), but moved to the first CC/first intercostal space (ICS) as the child grew. The SVC/RA junction was at the fourth CC in the youngest group and moved to the third CC/third ICS as the child grew. This study demonstrates the variable anatomy of SVC formation and the SVC/RA junction with respect to rib level. This variability underscores the unreliability of surface anatomical landmarks of the SVC/RA junction as a guide to catheter tip position.

show abstract

“…In this study, no specific relationship of the CVC depth of the EL and RL to patients' age was illustrated. Although the length and the position of the SVC‐RAJ were associated with age, our EL and RL were comparable to the TEE in all age‐groups. The measurement of specific patient anatomical distance as surrogated to their SVC‐RAJ distance regardless of their age may explain the satisfactory results.…”

Section: Discussionmentioning

confidence: 53%

“…The difference might be due to differences in the study population. In addition, our predetermined optimal target zone was narrower because the SVC length in children was shorter than in adults (4.5 vs 7.1 cm) …”

Section: Discussionmentioning

confidence: 99%

A Comparison of the external anatomical landmark and the radiological landmark for obtaining the optimal depth of a right internal jugular venous catheter in pediatric cardiac patients

Samerchua

Kongwatmai

Boonsri

et al. 2020

Pediatric Anesthesia

View full text Add to dashboard Cite

Background:The external anatomical landmark and the radiological landmark have been introduced to provide estimation of the depth of right internal jugular venous catheter during insertion. Aims:This study aimed to compare the accuracy, agreement, and reliability of the external anatomical landmark and the radiological landmark, confirmation being by transesophageal echocardiography.Methods: This prospective observational study was conducted in children ages 1-15 years. The catheter was placed at the superior vena cava and the right atrium junction guided by transesophageal echocardiography. The catheter depth derived from the transesophageal echocardiography, the external anatomical landmark, and the radiological landmark was recorded. The optimal zone of the catheter tip was 5 mm below and 10 mm above the superior vena cava and the right atrium junction.Accuracy was assessed by the difference between the transesophageal echocardiography and the external anatomical landmark or the radiological landmark. Agreement with Bland-Altman plots and correlation were tested.Results: Eighty participants, median age of 3 years, were enrolled. The median (IQR) differences between the depth of the transesophageal echocardiography and the external anatomical landmark or the radiological landmark were 0.30 (0, 0.70) and 0.10 (−0.20, 0.90) cm, respectively. Bland-Altman plots demonstrated good agreement between the depths. The catheter tips were located in the optimal zone more frequently with the external anatomical landmark than the radiological landmark (94.7% vs 64.5%). The external anatomical landmark showed a stronger correlation to transesophageal echocardiography than the radiological landmark (r = .95 vs .83). Conclusion:Both the external anatomical landmark and the radiological landmark enabled accurate estimation of the central venous catheter depth close to the superior vena cava and the right atrium junction. The external anatomical landmark is of more potential use than the radiological landmark in clinical practice. | 491 SAMERCHUA Et Al.

show abstract

Proper Tip Position of Central Venous Catheter in Pediatric Patients

Cited by 11 publications

References 17 publications

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

Defining the surface anatomy of the central venous system in children

A Comparison of the external anatomical landmark and the radiological landmark for obtaining the optimal depth of a right internal jugular venous catheter in pediatric cardiac patients

Contact Info

Product

Resources

About