Original Article
Simple formulas to determine optimal subclavian central venous catheter tip placement in infants and children

https://doi.org/10.1016/j.jpedsurg.2013.12.024Get rights and content

Abstract

Background/Purpose

Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children.

Methods

We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA).

Results

Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5*BSA + 7 cm, and for the right subclavian vein approach it was 5*BSA + 6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children.

Conclusion

The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.

Section snippets

Methods

We performed a retrospective review of 727 consecutive children, who underwent central venous catheter placement, by either the left (514) or right (213) subclavian vein approach, between January 1, 2005 and June 6, 2008, using a departmental billing database. Fourteen different pediatric general surgeons, all experienced in subclavian central venous line placement, placed approximately 50 catheters each. Given the retrospective nature of this study, it was not possible to determine how many

Results

Our study population ranged from 0.21 to 21.9 years of age with a mean age of 8.7 ± 6 years (Table 1). Weight ranged from 3.2 to 126.9 kilograms with a mean of 33.6 ± 23.7 kg, height from 37 to 194 cm with a mean of 124.1 ± 36.1 and BSA from 0.21 to 2.46 m2 with a mean value of 1.05 ± 0.51 m2. There were 397 boys and 330 girls, 514 of whom underwent left subclavian CVC insertion and 213 right subclavian CVC insertion. There were no significant differences in optimal CVC length identified between males and

Discussion

Determining the optimal central venous catheter insertion length via the subclavian approach would seem to be a simple maneuver, but is often fraught with error in children. Optimal tip positioning at the RA/SVC junction is vital to decrease the risk of cardiac arrhythmias, thrombosis secondary to endothelial damage, perforations, as well as to ensure optimal CVC function. The intraoperative insertion of the wrong length of catheter may lead to catheter removal and replacement, which may

Conclusions

We have devised two simple to use formulas that estimate the optimal length of CVC to insert into either subclavian vein to obtain proper catheter tip position in over 92% of smaller children and over 95% of larger children. The use of these formulas should provide improved efficiency and accuracy in subclavian venous catheter placement and decrease the rate of catheter malposition and its associated complications and inefficiencies. In the future, we plan to evaluate the application of these

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