Correct Tip Position of Central Venous Catheters

Assessment of the Correct Tip Position of Central Venous Catheters, Inserted Using Patient's Height Formula

Patients, ages between 18-70 years, who require central venous catheter will be enrolled for the study. Central venous catheter will be inserted using patient's height formula by Seldinger technique. Anterioposterior chest radiography will be used to assess the correct tip position. Catheters that are below the carina more than 1 cm, will be pulled back for repositioning. Catheters that are above the carina more than 1 cm, will be changed by another catheter. The investigators aim to evaluate the formula for correct tip positioning for central venous catheters

Study Overview

• Status: Completed
• Conditions: Central Venous Catheter; Radiography; Internal Jugular Vein; Subclavian Vein Injury

Detailed Description

Central venous catheters are used for fluid infusion, nutrition, blood transfusion, hemodynamic monitorization in both intensive care unit and operating room. The superior vena cava and right atrium (SVC-RA) junction is considered the optimal position for central venous catheter tip. Carina corresponds to the SVC-RA junction on chest radiograph. Catheter tips, 1 cm above and 1 cm below the carina are considered as the correct position. 18-70 years old patients will be enrolled for the study. Central venous catheters will be inserted via internal jugular vein or subclavian vein using patient's height formula by Seldinger technique. Postprocedural (within 6 hours) chest radiograph will be used to evaluate the correct tip position from the Picture Archiving and Communication System. This formula was described by Peres. If the tip of the catheter is below the carina more than 1 cm, it will be pulled back for repositioning. If the tip of the catheter is above the carina more than 1 cm, another catheter will be inserted. The formula is height (cm)/10 for right internal jugular vein, height(cm)/10-2 for right subclavian vein, height(cm)/10+4 for left internal jugular vein and height(cm)/10+2 for left subclavian vein. Number of the correct and incorrect position of central venous catheter tips will be noted.

The investigators aim to evaluate the reliability and efficiency of Peres' formula for the correct tip position.

• Study Type: Observational
• Enrollment (Actual): 300

Contacts and Locations

Study Locations

• Turkey
  • Izmir, Turkey
    • Izmir Bozyaka Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients in intensive care unit and operating room who require a central venous catheter (right or left-sided) will be enrolled for the study.

Description

Inclusion Criteria:

• Central venous catheterization of patients, ages between 18 and 70

Exclusion Criteria:

• Patient's refusal
• Pathology of carotid artery
• Anatomical deformity of the neck (scar, mass effect, multiple central venous catheterization)
• Chest deformities (pectus excavatum, pectus carinatum)

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of correct position of central venous catheter tip	Central venous catheter tip should be placed at the superior vena cava and right atrium junction. This junction is defined as carina in anteroposterior chest x-ray imagining. Correct tip position is defined as 1 cm above and 1 cm below the carina.Postprocedural chest radiography will be used.	Within 6 hours after placement of central venous catheter

Collaborators and Investigators

• Sponsor: Bozyaka Training and Research Hospital
• Investigators: Study Chair: Halide H Şahinkaya, MD, Izmir Bozyaka Training and Research Hospital; Study Chair: Mine Parlak, MD, Izmir Bozyaka Training and Research Hospital; Study Chair: Zeki T Tekgül, MD, Izmir Bozyaka Training and Research Hospital

Publications and helpful links

General Publications

• Joshi AM, Bhosale GP, Parikh GP, Shah VR. Optimal positioning of right-sided internal jugular venous catheters: comparison of intra-atrial electrocardiography versus Peres' formula. Indian J Crit Care Med. 2008 Jan;12(1):10-4. doi: 10.4103/0972-5229.40943.
• Kujur R, Rao MS, Mrinal M. How correct is the correct length for central venous catheter insertion. Indian J Crit Care Med. 2009 Jul-Sep;13(3):159-62. doi: 10.4103/0972-5229.58543.
• Salimi F, Imani MR, Ghasemi N, Keshavarzian A, Jazi AH. The mid-sternal length, a practical anatomical landmark for optimal positioning of long-term central venous catheters. J Res Med Sci. 2013 May;18(5):383-6.

Study record dates

Study Major Dates

• Study Start (Actual): July 8, 2018
• Primary Completion (Actual): January 1, 2022
• Study Completion (Actual): March 31, 2022

Study Registration Dates

• First Submitted: November 27, 2021
• First Submitted That Met QC Criteria: December 14, 2021
• First Posted (Actual): January 4, 2022

Study Record Updates

• Last Update Posted (Actual): May 12, 2023
• Last Update Submitted That Met QC Criteria: May 11, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: carina; central venous catheter insertion; Peres' formula; correct tip position
• Other Study ID Numbers: Catheter

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No