An estimation of right and left sided central venous catheter insertion depth using measurement of surface landmarks along the course of central veins -a descriptive observational study

Abstract

Aim and Objectives: To determine whether the measurement of surface landmarks along the course of central veins can estimate the approximate insertion depths of both right and left sided C.V.C. via the internal jugular veins (I.J.V.) and subclavian veins (S.C.V.). Methods: Total 150 central venous catheterizations were performed using a triple lumen C.V.C. with Seldinger technique. The anterior approach, using the sternocleidomastoid muscle as a landmark was used for I.J.V. insertion and infraclavicular approach for S.C.V. insertion. Topographical measurement was done by placing the catheter naturally with its own curvature over the draped skin, starting from the insertion point of the needle through ipsilateral clavicular notch and to the insertion point of second right coastal cartilage to the manubriosternal joint. The C.V.C. was then inserted and secured to a depth determined topographically. The position of C.V.C. tip, in relation to the carina, was confirmed and measured on a post procedural full inspiration chest X ray. Results: The mean (SD) depth of insertion of Right I.J.V., Right S.C.V., Left I.J.V. and Left S.C.V were 12.26 (0.30) cm, 12.86 (0.36) cm, 16.27 (0.22) cm and 16.30 (0.23) cm respectively. The mean (SD) value for vertical distance between C.V.C. tip and carina of Right I.J.V, Right S.C.V., Left I.J.V. and Left S.C.V were 0.38 (0.26) cm, 0.43 (0.27) cm, 0.41 (0.23) cm and 0.55 (0.29) cm respectively. We found no statistically significant difference in incidence of complications and type of C.V.C inserted but statistical significant difference found between incidence of complications and Position of CVC Tip on Post-procedure Chest X-ray. Conclusion: The approximate insertion depth of a CVC can be estimated using measurement of surface landmarks along the pathway of central veins.