The Optimal Length of Insertion for Central Venous Catheters Via the Right Internal Jugular Vein in Pediatric Cardiac Surgical Patients

Optimization of Right Internal Jugular Central Venous Catheter Length in Pediatric Cardiac Surgical Patients

“…To complete this objective, the authors prospectively applied 4 commonly used techniques for CVC placement to a randomized cohort of pediatric patients to determine the optimal technique for CVC tip placement, defined by both accuracy and reproducibility of localization. 6 For their study, 120 patients were randomly assigned into 4 equal groups. The optimal catheter tip position chosen for their study was based on a prior adult cadaveric study that adopted the carina as a reproducible landmark above the pericardial sac as it transverses posterior to the superior vena cava (SVC).…”

“…Finally, in group 4, the length of the catheter was determined by a height-based formula. 6 Their study found that the most accurate method to determine the optimal catheter tip within 1.5 cm of the carina was the distance from the skin puncture site to the second intercostal space as measured using postoperative chest x-ray. 6 This well-designed study addressed a critical need for reproducibility and accuracy in CVC placement and localization.…”

“…6 Their study found that the most accurate method to determine the optimal catheter tip within 1.5 cm of the carina was the distance from the skin puncture site to the second intercostal space as measured using postoperative chest x-ray. 6 This well-designed study addressed a critical need for reproducibility and accuracy in CVC placement and localization. CVC placement carries inherent risk, and appropriate localization for pressure monitoring and medication delivery is clinically very important.…”

“…In the study by Maddali et al, the skin entry site was reproducible, irrespective of patient size, and was selected as the midpoint between the tip of the right mastoid process and clavicular insertion of the right sternocleidomastoid muscle. 6 Techniques that have been proposed to ensure the correct position of the distal tip of the catheter include anatomic surface landmarks, height-based formulae, procedural fluoroscopy, chest radiography, and cardiac ultrasonography. * 1,4,5,7,22,23 Landmarks proposed by Maddali et al for accurate central venous cannula tip placement provided an efficient and reproducible method to estimate catheter length.…”

“…As highlighted in their study, this did not, however, account for optimal placement in the setting of anatomic variations, which should be defined preprocedurally. 6 The risk of mechanical injury can be decreased greatly with the use of procedural ultrasound for precise CVC insertion. Ultrasound has been proven to increase the successful initial attempt at venous cannulation in pediatric and underweight adult cardiac surgical patients.…”