Abstract PR280

Abstract

Background & Objectives: Central venous catheters (CVCs) are necessary for pediatric cardiac anesthesia, and malposition of these can lead to various complications (e.g., cardiac perforation, cardiac tamponade, inaccurate central venous pressure). The CVC tip should ideally be placed above the superior vena cava-right atrial junction. However, positioning the CVC tip properly, especially in small children, is difficult. We assumed that the puncture site (lower or higher part of the neck) affects depth of CVC, especially in infants. So, we examined the distance from puncture site to inferior border of clavicle as an anatomic landmark for determining the optimal CVC depth in infants. Materials & Methods: Consecutive infants in whom central catheters were inserted in the right internal jugular vein from December 2012 to November 2015 were evaluated retrospectively. After obtaining hospital IRB approval and informed consent, 32 infants undergoing surgery for congenital heart disease were enrolled in this study. Central venous catheterization was performed under real-time echo guidance. The distance between the insertion point of needle and inferior border of clavicle was measured perpendicularly using a sterile disposable ruler. The insertion depth of CVC was determined by adding 1-2 cm to the distance from the puncture site to inferior border clavicle depending on the patients’ physique. The longitudinal distance between the carina and the CVC tip was measured using chest radiography. We determined the ideal position of the tip of CVC was 1 cm above the carina, as the carina is 0.2-1.0 cm above the pericardial reflection in small children1). For ideal insertion depth of CVC, we calculated the difference between actual and ideal CVC tip position. Demographic data are presented as median (range). Simple linear regression analysis was performed using the least-squares method. Results: The median (range) demographics are as follows: age, 4 months (2 days-11 months); height 61 cm (40-71 cm); weight, 5.6 kg (2-8.4 kg). The optimal insertion depth of CVC showed higher correlation with distance from skin puncture site to the inferior border of the clavicle (r = 0.83 than the patient’s height (r = 0.48) and weight (r = 0.47). According to our results, insertion depth could be predicted using the formula: insertion depth (mm) = 14.4 + 0.96 × (distance from puncture site to inferior border clavicle) Conclusion: We determined that the distance between the insertion point of needle and inferior border of clavicle is useful to determine appropriate insertion depth of CVC in infants and is a practical surface landmark for determining the insertion depth of CVC in infants.