Bedside prediction of right subclavian venous catheter insertion length

Abstract

Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively). Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14 ± 0.53, 2.19 ± 1.17, and −0.45 ± 0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm) = −0.037 + 0.036 × Height (cm) + 0.903 × I-T-IC (cm) (adjusted r 2 = 0.64). Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients

“…16) suggested that the optimal position for the tip of the CVC extends two vertebral bodies below the carina. Weight-based formulas exist for pediatric patients to help guide CVC selection, and adult studies have evaluated anthropomorphic measurements to determine the optimal length of the CVC prior to insertion (17)(18)(19)(20). These formulas may result in imprecise target insertion depths in pediatric patients due to factors such as manufacturer predetermined catheter sizes, institutional preferences concerning CVC securement, or the use of newer CVC insertion techniques to access the supraclavicular SC, axillary and brachiocephalic vein renders the application of anthropomorphic calculations difficult or impossible (21)(22)(23).…”

A retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants: landmark-based estimation vs. linear regression model

“…However, the optimal length of catheter insertion in pediatric patients undergoing subclavian venous catheterization has not been determined. Most methods suggested to date utilize an approach through the internal jugular vein or are less intuitive [6][7][8][9].…”