Depth Of Insertion Of Right Internal Jugular Central Venous Catheter: Comparison Of Landmark Versus Formula Method

Abstract

Background and aims: Central venous catheterization (CVC) is a vital procedure in major surgeries and also in critically ill patients for volume resuscitation, central venous pressure (CVP) monitoring, Misplacement of the catheter tip can cause lethal complications such as hemothorax, hydrothorax, or cardiac tamponade. The superior vena cava-right atrium (SVC-RA) junction is considered the optimal position for the central venous catheter tip. In this study, we wanted to compare the accuracy of central line placement using a post-operative chest x-ray using the landmark technique and the formula technique of peres.

Method: 40 Patients within the height range of 140-160cm were chosen for the study.20 patients in Group A/peres formula (height in cm/10) and Group B/Landmark technique. The position of CVC tip, in relation to the carina, was measured on a post -procedure chest X-ray from the PACS. CVC tips positioned above the carina were presented as positive values, and those below the carina were presented as negative values. Catheter tip position was considered acceptable if it was in the range of up to 5 cm above and up to 1 cm below the carina.

Result: Distribution of position of central line tip from carina was comparable between group A and B. (-3:-0% vs 5% respectively, -2:-0% vs 15% respectively, -1:-20% vs 15% respectively, 0:-5% vs 15% respectively, 1:-40% vs 20% respectively, 2:-20% vs 20% respectively, 3:-10% vs 5% respectively, 4:-5% vs 5% respectively) (p-value=0.495).Distribution of proper/improper placement was comparable between group A and B. (Proper placement:- 100% vs 80% respectively, Improper placement:- 0% vs 20% respectively) (p value=0.106)

Conclusion: It can be inferred that in a height range of 140-160cm using the peres formula or the landmark formula will give an approximate depth estimation for central line placement but the result will not be statistically significant. This means that using either technique there is a very high chance the central line tip will be in anatomically correct position and repositioning will not be require.