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

Abstract

Several formulae or methods are reported to predict the ideal central venous catheter insertion depth. However, they are complicated and often unsuitable in cases requiring rapid management. This study aimed to determine a simple and practical method to predict the ideal central venous catheter insertion depth after the real-time ultrasound-guided right internal jugularvein, or left or right supraclavicular approach in pediatric patients. Pediatric patients with congenital heart diseases who underwent cardiovascular surgery between July 2015 and February 2018 in the German Pediatric Heart Center Sankt Augustin were enrolled.Body height, body weight, patient age (months), and central venous catheterinsertion depth were retrieved from the anesthesia records. Idealcentral venous catheter insertion depth was calculated by measuring the distance between the level of the carina tracheae and the central venous catheter tip on the first postoperative chest radiograph. The relationships of body height, body weight, and patient age (months) to ideal central venous catheter insertion depth for the right internal jugular, left supraclavicular, and right supraclavicular approaches were investigated. Body height was the best parameter, providing the best coefficients of determination as well as the simplest relationship. Based on analysis for ideal central venous catheterinsertion depth for every 10-cm increase in body height, there was an ideal central venous catheterinsertion depth for each body height, independent of the anesthesiologist's experience with the approach used. Whereas ideal central venous catheterinsertion depths for the right internal jugular vein approach and the left supraclavicular approach showed no significant difference, ideal central venous catheterinsertion depth for the right supraclavicular approach was significantly shorter than that of the other two approaches. This study successfully determined a visually simple and practical bar graph to predict the ideal central venous catheterdepth inserted using only the real-time ultrasound-guided insertion technique for the right internal jugular vein, left supraclavicular, and right supraclavicular approaches.