Journal of Cardiothoracic and Vascular Anesthesia
Volume 21, Issue 4 , Pages 497-501 , August 2007

Correct Depth of Insertion of Right Internal Jugular Central Venous Catheters Based on External Landmarks: Avoiding the Right Atrium

Presented as an abstract at the ASA Meeting, Atlanta, GA, October 25, 2005.

  • Tiberiu Ezri, MD

      Affiliations

    • Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel
    • Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
    • Outcomes Research Institute, University of Louisville, Louisville, KY.
    • ,
  • Marian Weisenberg, MD

      Affiliations

    • Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel
    • Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
    • ,
  • Daniel I. Sessler, MD

      Affiliations

    • Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
    • Outcomes Research Institute, University of Louisville, Louisville, KY.
    • ,
  • Haim Berkenstadt, MD

      Affiliations

    • Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
    • Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
    • ,
  • Sorin Elias, MD

      Affiliations

    • Department of Radiology, E. Wolfson Medical Center, Holon, Israel
    • Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
    • ,
  • Peter Szmuk, MD

      Affiliations

    • Department of Anesthesiology, UT Medical School at Houston, Houston, TX
    • Outcomes Research Institute, University of Louisville, Louisville, KY.
    • ,
  • Francis Serour, MD

      Affiliations

    • Department of Pediatric Surgery, E. Wolfson Medical Center, Holon, Israel
    • Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
    • Corresponding Author InformationAddress reprint requests to Francis Serour, MD, Department of Pediatric Surgery, E. Wolfson Medical Center, Halokhamim Street 62, Holon 58100, Israel.
    • ,
  • Shmuel Evron, MD

      Affiliations

    • Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel
    • Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
    • Outcomes Research Institute, University of Louisville, Louisville, KY.

References 

  1. Food and Drug Administration. Precautions necessary with central venous catheters (FDA Task Force). FDA Drug Bull. 1989;15–16July
  2. McGee WT, Ackerman BL, Rouben LR, et al. Accurate placement of central venous catheters: A prospective, randomized, multicenter trial. Crit Care Med. 1993;21:1118–1123
  3. Chalkiadis GA, Goucke CR. Depth of central venous catheter insertion in adults: An audit and assessment of a technique to improve tip position. Anaesth Intensive Care. 1998;26:61–66
  4. Losert H, Prokesch R, Grabenwoger M, et al. Inadvertent transpericardial insertion of a central venous line with cardiac tamponade failure of preventive practices. Intensive Care Med. 2000;26:1147–1150
  5. Booth SA, Norton B, Mulvey DA. Central venous catheterization and fatal cardiac tamponade. Br J Anaesth. 2001;87:298–302
  6. Forauer AR, Dasika NL, Gemmete JJ, et al. Pericardial tamponade complicating central venous interventions. J Vasc Interv Radiol. 2003;14:255–259
  7. Madias JE. Intracardiac (superior vena cava/right atrial) ECGs using saline solution as the conductive medium for the proper positioning of the Shiley hemodialysis catheter: Is it not time to forego the postinsertion chest radiograph?. Chest. 2003;124:2363–2367
  8. Chu KS, Hsu JH, Wang SS, et al. Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography. Anesth Analg. 2004;98:910–914
  9. Schummer W, Schummer C, Schelenz C, et al. Central venous catheters—The inability of ‘intra-atrial ECG’ to prove adequate positioning. Br J Anaesth. 2004;93:193–198
  10. Schummer W, Herrmann S, Schummer C, et al. Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters. Br J Anaesth. 2003;91:481–486
  11. Reeves ST, Bevis LA, Bailey BN. Positioning a right atrial air aspiration catheter using transesophageal echocardiography. J Neurosurg Anesthesiol. 1996;8:123–125
  12. Kim KO, Jo JO, Kim HS, et al. Positioning internal jugular venous catheters using the right third intercostal space in children. Acta Anaesthesiol Scand. 2003;47:1284–1286
  13. Schuster M, Nave H, Piepenbrock S, et al. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000;85:192–194
  14. Vesely TM. Central venous catheter tip position: A continuing controversy. J Vasc Interv Radiol. 2003;14:527–534
  15. Ellis H, Feldman S. In: Anatomy for Anaesthetists. (ed 3). Oxford: Blackwell Scientific Publications; 1979;p. 49
  16. Hayashi H, Ootaki C, Tsuzuku M, et al. Respiratory jugular venodilation: A new landmark for right internal jugular vein puncture in ventilated patients. J Cardiothorac Vasc Anesth. 2000;14:40–44
  17. Peres PW. Positioning central venous catheters—A prospective survey. Anaesth Intensive Care. 1990;18:536–539
  18. Eagle CC. The relationship between a person’s height and appropriate endotracheal tube length. Anaesth Intensive Care. 1992;20:156–160
  19. McGee WT, Moriarty KP. Accurate placement of central venous catheters using a 16-cm catheter. J Intensive Care Med. 1996;11:19–22
  20. Rutherford JS, Merry AF, Occleshaw CJ. Depth of central venous catheterization: An audit of practice in a cardiac surgical unit. Anaesth Intensive Care. 1994;22:267–271
  21. Aslamy Z, Dewald CL, Heffner JE. MRI of central venous anatomy: Implications for central venous catheter insertion. Chest. 1998;114:820–826
  22. Karnauchow PN. Cardiac tamponade from central venous catheterization. Can Med Assoc J. 1986;135:1145–1147
  23. Ellis LM, Vogel SB, Copeland EM. Central venous catheter vascular erosions (Diagnosis and clinical course). Ann Surg. 1989;209:475–478

 Supported by NIH Grant GM 061655 (Bethesda, MD), the Gheens Foundation (Louisville, KY), the Joseph Drown Foundation (Los Angeles, CA), and the Commonwealth of Kentucky Research Challenge Trust Fund (Louisville, KY).

PII: S1053-0770(06)00232-1

doi: 10.1053/j.jvca.2006.05.011

Journal of Cardiothoracic and Vascular Anesthesia
Volume 21, Issue 4 , Pages 497-501 , August 2007

Article Tools

* Image Usage & Resolution