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How Long Should an Internal Jugular Catheter Be?

Nixon, Chris

doi: 10.1213/00000539-200002000-00055
Letters to the Editor
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Starship Children’s Hospital Auckland, New Zealand

The report by Leech et al. (1) describes the unfortunate consequences of central venous catheter placement within the pericardial reflection, and the authors are to be congratulated on their successful management. We have struggled with the correct length for placement of central venous lines via the internal jugular route and have audited all central lines, taking the right bronchial origin as the ideal tip position at radiography (2,3). Regression lines for catheter length with respect to age, weight, and height were constructed. The best correlate for length was weight, with a regression line of 0.13 × weight (kg) + 4.9 cm and correlation coefficient of 0.90. For a 7-kg infant, the predicted length is 5.8 cm. For practical purposes, 5-cm lines may be used for 5- to 15-kg infants, 8 cm lines for children of 15- to 40-kg and 13 cm lines for those over 40 kg. Formulas based on patient height also provide reasonable predictions for insertion length: from Czepizak et al. (4), (Ht in cm/10) −1. Large multilumen catheters increase the risk of vessel wall perforation (5) and may explain the rapid onset in this patient. Our hope is that length selection based on this formula will reduce repeat radiography and catheter-related morbidity.

Chris Nixon

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References

1. Leech RC, Watts ADJ, Heaton ND, Potter DR. Intraoperative cardiac tamponade after central venous cannulation in an infant during orthotopic liver transplantation. Anesth Analg 1999; 89:342–3.
2. Rutherford JS, Merry AF, Occleshaw CJ. Depth of central venous catheterisation: an audit of practice in a cardiac surgical unit. Anaesth Intensive Care 1994; 22:267–71.
3. Aslamy Z, Dewald CL, Heffner JE. MRI of central venous anatomy: implications for central venous catheter insertion. Chest 1998; 114:820–6.
4. Czepizak CA, O’Callaghan JM, Venus Bahman. Evaluation of formulas for optimal positioning of central venous catheters. Chest 1995; 107:1662–64.
5. Gravenstein N, Blackshear RH. In vitro evaluation of the relative perforating potential of central venous catheters: comparison of materials, selected models, number of lumens and angles of incidence to simulated membrane. J Clin Monit 1991; 7:1–6.
© 2000 International Anesthesia Research Society