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Abstract
The Food and Drug Administration guidelines suggest that the tip of a CVC should not be positioned in the right atrium and current guidelines strongly advise that the CVC tip lies in the SVC and outside the pericardial sac to avoid the danger of complications. Cardiac tamponade secondary to catheter tip perforation of the cardiac wall is not rare, and two-thirds of patients who experience this complication die. Other problems of catheter placement in the RA include arrhythmias, placement in the coronary sinus, and tricuspid valve damage. Precalculation of the length of insertion according to topographic measurements may save unnecessary repositioning of CVCs and may avoid complications related to too distal or proximal insertions.
The aim of this prospective study was to assess the accuracy of a method of right internal jugular CVC positioning, based on external topographic landmarks and its comparison with the fixed predetermined 15cm depth insertion method. This study was conducted on 100 adult patients, selected from those who were admitted to the Critical Care Medicine Department of Alexandria Main University Hospital and required RIJC CVCs.
Two methods of RIJV CVC insertion were carried in all patients enrolled in the study:
The topographic method length: in which the depth of CVC insertion was calculated from the external topographic landmarks represented by the thyroid to manubrium distance in cm for each patient. The conventional method length: The depth of CVC insertion was 15 cm from the insertion site.
The following parameters were measured in each patient following each method of catheterization:
1. Vertical distance in cm from CVC tip to the carina on CXR.
2. CVP.
3. Blood gas analysis for ScvO2%.
A screening study involving 20 patients was done in our critical care unit to assess the incidence of CVCs malpositioning where 20 chest x-ray belonging to 20 patients who underwent a RIJV CVC insertion using landmarks of the central approach were analyzed for CVC tip position in reference to the carina in the same way in this study and results were compared with the external topographic method.
The following results were obtained:
1. There was weak non significant correlation between patient’s height the thyroid to manubrium distance.
2. There was weak non significant correlation between patient’s BMI and the thyroid to manubrium distance.