Determination of the optimal depth of a left internal jugular venous catheter in infants: A prospective observational study

Abstract

In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.

A new way to determine correct depth of central venous catheter insertion using a real‐time ultrasound‐guided insertion technique in pediatric patients

“…However, the current study focused on determining a simpler and more practical method usable in daily clinical practice to predict the ideal CVC depth of insertion using only the real‐time ultrasound‐guided insertion technique without any other measurement procedures. Therefore, this study defined the level of the carina tracheae as the ideal location of the CVC tip, as numerous reports have suggested calculation formulae for ideal CVC insertion depth defining the level of the carina tracheae as the ideal CVC tip location . For the same reasons, we have compared ideal CVC depths of insertion between patients for Glenn/Fontan operations and those for other operations by defining the level of the carina tracheae as the ideal location of the CVC tip.…”

“…Appropriate location of the CVC tip is important, because a CVC placed too deep in the right atrium can interrupt the operative manipulation in heart surgery with cardiopulmonary bypass (CPB), can be unusable during CPB, and can lead to life‐threatening complications such as arrhythmia, thromboses, cardiac perforation, or pericardial tamponade . Numerous reports have suggested formulae to calculate the ideal CVC insertion depth based on body characteristics (height, weight, or age) in adult and pediatric patients, defining the level of the carina tracheae as the ideal location of the CVC tip, as it corresponds to the level of connection between the superior vena cava (SVC) and right atrium . However, these formulae are complex.…”

“…However, these formulae are complex. Methods employing transesophageal echocardiography (TEE), an intracavitary electrocardiography (ECG)‐guided system, and computed tomography (CT) have been reported. However, TEE, the intracavitary ECG‐guided system, or CT are not always available.…”

“…However, TEE, the intracavitary ECG‐guided system, or CT are not always available. Other reports have introduced measurement methods using external landmarks to determine the ideal CVC insertion depth for the internal jugular vein approach in pediatric patients and subclavian vein approaches in pediatric patients and adults . However, these procedures are complicated and often unsuitable in cases requiring rapid management.…”

“…This study considered the right internal jugular vein approach as the most popular approach for anesthesia management and emergencies, the left supraclavicular approach as an easy‐to‐learn alternative approach, and the right supraclavicular approach as a promising alternative . While preceding reports used the landmark‐guided puncture method, we investigated a new approach in determining the ideal depth for CVC insertion after a real‐time ultrasound‐guided insertion technique; thus, skin puncture points may differ between these two methods. The secondary aim of this study was to evaluate the hypothesis that there could be a difference in ideal CVC insertion depth between patients undergoing the Glenn/Fontan operation and those undergoing other operations; this is because the positional relation of the carina tracheae and right SVC can be changed by the operation per se.…”