The mid-sternal length, a practical anatomical landmark for optimal positioning of long-term central venous catheters

Fereshte Salimi, Mohammad Reza Imani, Navab Ghasemi, Amir Keshavarzian, Amir Hosein Davarpanah Jazi, Fereshte Salimi, Mohammad Reza Imani, Navab Ghasemi, Amir Keshavarzian, Amir Hosein Davarpanah Jazi

Abstract

Background: Long-term tunneled catheters are used for the hemodialysis or chemotherapy in many patients. Proper placement of the catheter tip could reduce early and late catheter related complications. Aim of the present study was to evaluate a new formula for proper placement of tunneled hemodialysis or infusion port device by using an external anatomic landmark.

Materials and methods: A total of 64 adult patients undergoing elective placement of tunneled Central Venous Catheter (CVC) requiring hemodialysis or chemotherapy were enrolled in this prospective study during 2011-2012 in the university hospital. The catheter length to be inserted in the right internal jugular vein (IJV) was calculated by adding two measurements (the shortest straight length between the insertion point of the needle and the suprasternal notch plus and half of sternal length). The catheter position was considered correct if the tip was positioned in the right atrium (RA) or Superior vena cava (SVC)-RA junction.

Results: The patients were 55.28 ± 19.85 years of age, weighed 5.78 ± 16.62 kg and were 166.07 ± 10.27 cm tall. Catheters were inserted successfully in 88% of patients (n = 56). Catheter tip positions in the failures were SVC (n = 5), tricuspid valve (n = 2), and right ventricle (n = 1) in our patients.

Conclusion: Long-term hemodialysis or port CVC could easily insert in the right IJV by using half of the sternal length as an external land marks among adult patients.

Keywords: External landmark; hemodialysis; port device.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Method for determining the insertion depth of tunneled catheter. Two points are marked on the patient's skin during the catheterization. Point A is marked at supra-sterna notch. Point B is marked at the midpoint of the sternal length. Point I is the insertion point of the needle. Distance from Point I to Point A and from Point A to Point B is measured. The depth of the catheter is determined by adding the two measurements
Figure 2
Figure 2
(a-f) different steps of catheter placemen. (a) measurement of insertion depth, (b) creation of the sterile field, (c) insertion of guidewire, (d) creation of tunnel, (e) passing the catheter into the vein, (f) completion of procedure
Figure 3
Figure 3
Echocardiogram showed the catheter tip in upper third of the right atrium (black marker)

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