Assessment of correct central venous line placement.

Abstract

AnaesthesiaVolume 57, Issue 12 p. 1223-1223 Free Access Assessment of correct central venous line placement First published: 18 November 2002 https://doi.org/10.1046/j.1365-2044.2002.02913_17.xCitations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Much has been written recently regarding the correct tip position of a central venous catheter (CVP) sited within the mediastinum. Schuster et al. [1] recommend the carina as a radiological landmark as it appears at or close to the pericardial reflection, and siting the tip in the superior vena cava (SVC) above the carina will avoid the small yet possibly avoidable complications of pericardial perforation and right atrial migration. Fletcher & Bodenham, in their editorial on correct line placement [2], recommend vascular catheter placement in a vessel such that the tip is parallel to the vessel wall, lessening the risk of perforation, and that placement in the upper right atrium does not increase the risk. They regard up to 3 cm below the carina as a safe distance. We report a retrospective audit of CVP line tip position on ICU patients using a novel technique for measuring the pericarinal distance. Our hospital has a filmless radiological Patient Archiving & Communication System (PACS) (GE Medical Systems) facility whereby diagnostic radiological investigations such as X-rays, ultrasound, MRI and CT scans are stored as digital images on a central computer and viewed on high-resolution electronic screens sited throughout the hospital. The audit consisted of a retrospective study of all chest X-rays performed on patients admitted to the Intensive Care Unit over a 3-month period. As the chest X-rays are digitally reproduced, accurate measurements of the distance from the carina to the central venous catheter tip could be easily made using the viewing software. A distance within 3 cm above or below the carina was felt to be an acceptable position. The number of lines repositioned, obvious from review of later chest X-rays, was noted. Complications from line tip position were known from discussion with the consultant intensivists. The audit revealed that 118 CVP lines were inserted in 103 patients over the 3-month study period and 74 lines (63%) were within 3 cm above or below the carina. Of the remaining lines, two were malpositioned and removed, one line was greater than 3 cm above the carina and this was not adjusted, and 41 (35%) were below the 3-cm mark, of which three were adjusted. No complications arose attributable to vessel perforation or pericardial tamponade. This audit used the PACS system as a novel, previously unreported method of accurately and easily measuring the pericarinal distance. Despite a large proportion of CVP line tips being placed below the ‘safe’ pericarinal zone, no complications were observed, and we suspect that placement of tips in this area is common due to the relatively long lengths of central venous catheters typically available. This audit has raised awareness of CVP line position within our ICU, and has utilised available technology to do this. A. PollardR. V. Johnson The Calderdale Royal Hospital, Halifax HX3 0PW, UK References 1 Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. British Journal of Anaesthesia 2000; 85: 192– 4. 2 Fletcher S, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? British Journal of Anaesthesia 2000; 85: 188– 91. Citing Literature Volume57, Issue12December 2002Pages 1223-1223 ReferencesRelatedInformation