Evaluation of a central venous catheter tip placement for superior vena cava-subclavian central venous catheterization using a premeasured length: A retrospective study

Abstract

Subclavian central venous catheterization is a common procedure for which misplacement of the central venous catheter (CVC) is a frequent complication that can potentially be fatal. The carina is located in the mid-zone of the superior vena cava (SVC) and is considered a reliable landmark for CVC placement in chest radiographs. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured in posteroanterior chest radiographs using a picture archiving and communication system. To evaluate the placement of the tip of the CVC in subclavian central venous catheterizations using the C-length, we reviewed the medical records and chest radiographs of 122 adult patients in whom CVC catheterization was performed (from January 2012 to December 2014) via the right subclavian vein using the C-length. The tips of all subclavian CVCs were placed in the SVC using the C-length. No subclavian CVC entered the right atrium. Tip placement was not affected by demographic characteristics such as age, sex, height, weight, and body mass index. The evidence indicates that the C-length on chest radiographs can be used to determine the available insertion length and place the right subclavian CVC tip into the SVC.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1

Diagram of the C-length and the zone of central venous catheter placement. C-length (straight arrow line) was defined as the distance from the edge of the right transverse process of the first thoracic spine (T1) to the carina. C = level of the carina, J = SVC/RA junction, lower SVC = between the carina and 3 cm below it, RA (right atrium) = below the J, SVC = superior vena cava, upper SVC = between the carina and 3 cm above it. Adapted from Lee and Lee.[12]

Figure 2

Scatter plot of tip placement of subclavian CVCs using the C-length from a chest radiograph. CVC = central venous catheter, lower SVC = between the carina and 3 cm below it, SVC = superior vena cava, upper SVC = between the carina and 3 cm above it. The gray shade indicates the zone of SVC.

Figure 3

Relationship between tip placement of subclavian CVCs and BMI on chest radiographs. BMI = body mass index, CVC = central venous catheter. The gray shade indicates the zone of the superior vena cava.