Depth of Central Venous Catheterization by Intracardiac ECG in Paediatric Patients

Abstract

Background: Central venous catheterization is a frequent procedure in cardiac surgery and intensive care setting. Its faulty positioning can cause severe complications, which can be fatal and erroneous central venous pressure measurement. Methods: In this prospective study, the right internal jugular vein (IJV) was cannulated in cardiac surgery patients over a period of four months and catheter tip positioning was guided by means of intracardiac ECG. The insertion depth was registered at the position of maximum P-wave amplitude and the catheter was fixed after withdrawing a further two cm. Pearson’s correlation coefficient was calculated to categorize any relation between height, body weight or body surface area (BSA) and the depth of insertion required to locate correct positioning. Plots of distance versus patient’s height were made, and regression lines and equations were calculated. Bland-Altman analysis of data was done to compare the old formulae with our derived formulae. 155 adult patients were studied. Results: Distances measured were found to be highly correlating with patient’s height, followed by body surface area (BSA) and weight. For right IJV cannulation in valvular surgeries in adults, the depth of insertion (cm) was (Height in cm / 15) + 2 and in non-valvular surgeries in adults, it was (Height in cm / 15) + 1.4. Conclusions: The devised formulae accurately predicted the required depth of catheters thereby reducing the possibility of complications and need for radiographic confirmation. doi:10.4021/ijcp17e