Cardiac tamponade and central venous catheters.

Optimal placement of CVP catheter in paediatric cardiac patients

“…chose the levels of T3, T4 and T5 as the sites of the optimal placement and analyzed the relationship between catheter depth and height. Although the SVC is not clearly identified in the chest x-ray, Greenhall et al 8 suggested that the tip should lie no more than 2 cm below a line joining the lower surfaces of the ends of the clavicles on a chest x-ray in adult population. The area of theirs is similar to ours, although ours is a little wider than theirs.…”

Central venous catheterization—An anatomical review of a clinical skill—Part 1: Subclavian vein via the infraclavicular approach

“…Furthermore, the catheter should lie parallel to the wall of the superior vena cava. One study reports a mortality rate of 87% in patients developing cardiac tamponade (Greenall et al, 1975). Collier et al (1984) reports that cardiac tamponade develops due to prolonged contact of the rigid catheter with the myocardial wall.…”

“…Aslamy et al (1998) argues convincingly that the absence of normative data to determine the dimensions of central venous vasculature and relationships of venous structures with radiographic landmarks complicates confirmation of the location of the catheter tip. It is proposed that the caudad margins of the clavicles correspond with the origin of the superior vena cava (Greenall et al, 1975), or approximately at the intervertebral disk between the second and third thoracic vertebrae. Greenall et al (1975) suggests that the tip of the catheter should lie no more than 2 cm below a line drawn below the lower surface of each clavicle.…”

“…It is proposed that the caudad margins of the clavicles correspond with the origin of the superior vena cava (Greenall et al, 1975), or approximately at the intervertebral disk between the second and third thoracic vertebrae. Greenall et al (1975) suggests that the tip of the catheter should lie no more than 2 cm below a line drawn below the lower surface of each clavicle. None of these have been anatomically correlated and may well be of limited value due to the effects of parallax and radiographic technique.…”

“…Cardiac tamponade is prevented by using soft polyurethrane catheters, measuring the desired length of the catheter beforehand, securing the catheter tightly to the skin and confirming the position of the catheter with a chest X-ray (Greenall et al, 1975;Sheep and Guiney, 1982;Collier et al, 1984;Boon, 1998). Catheters with beveled edges are unacceptable.…”