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KMID : 0878620020060020086
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Korean Journal of Pediatric Anesthesia
2002 Volume.6 No. 2 p.86 ~ p.90
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Optinial Depth of Insertion of CVP Catheter Using the Right Third Intercostal Space in Children
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Kim Kyoung-Ok
Jo Ji-Yeon
Oh Ah-Young
Kim Hee-Soo
Kim Chong-Sung
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Abstract
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Background: Central venous catheter (CVC) is often placed for pressure measurement, drug and fluid therapy in children undergoing cardiac surgery. There is a higher chance of developing complications related to catheter position in cardiac patients because CVC usually remains in situ during postoperative period. In the present study, in order to develop a guideline for the optimal depth of the CVC in pediatric cardiac patient, we examined the relationship between the depth of the internal jugular vein catheter and the distance to the right third intercostal space.
Methods: We measured the distance between the skin puncture site for central venous catheterization and the right third intercostal space (SK-RTICS). Central venous catheterization was performed through the fight internal jugular vein. The catheter position was checked by a postoperative AP chest X-ray, and we measured the distance from the tip of CVC and the radiographic junction between superior vena cava and the right atrium (SVCRA) to calculate length from SK to SVCRA.
Results: There is significant correlation between SK-RTICS and SK-SVCRA. The formual is: SK-SVCRA=0.35 +0.98×SK-RTICS (r2=0.8554). Based on the data, we developed another simple formula which predicted that a CVC would be positioned above the RA 97% of the time: Initial length of insertion (cm)=(SK-RTICS in cm) - 1.
Conclusions: Simple formula was made to place the catheter tip above SVC/RA junction. By using the guideline developed in this study, the malposition of CVC can be prevented, lessening the incidence of rare but serious complication related to the catheter tip position.
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KEYWORD
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Central venous catheter, right third intercostal space
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