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Published on: December 23, 2014
Fluoroscopic landmark for SVC-RA junction for central venous catheter placement in children
B Connolly1, J B Mawson, C E MacDonald
1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada. bairbre.connolly@sickkids.on.ca
Insights
The sixth thoracic vertebra is a reliable landmark for placing central venous catheters in children. This radiographic marker aids in accurate tip placement at the superior vena cava-right atrial junction.
Area of Science:
- Pediatric radiology
- Vascular access procedures
- Medical imaging interpretation
Background:
- Central venous catheters are frequently inserted using image guidance.
- Optimal tip placement is typically at the superior vena cava-right atrial (SVC-RA) junction.
Purpose of the Study:
- To determine a radiographic landmark for the SVC-RA junction.
- To improve accuracy of central venous catheter tip placement in pediatric patients.
Main Methods:
- Retrospective review of 56 children's upper limb venous contrast studies.
- Analysis of SVC-RA junction location relative to radiographic landmarks.
Main Results:
- The SVC-RA junction was located at the sixth thoracic vertebral level in 92.5% of patients.
- The junction was consistently lower than the right main bronchus and cardiomediastinal contour notch.
Conclusions:
- The vertebral body serves as a practical and visible radiographic landmark.
- This landmark facilitates precise central catheter tip positioning in children.
Background:
Vascular access devices are commonly placed under image guidance. The usual aim is to place the tip at the superior vena cava-right atrial junction (SVC-RA).
Objective:
To identify a radiographic landmark for the SVC-RA junction that would be useful for accurate central venous catheter tip placement in children.
Materials And Methods:
Images from 56 children undergoing contrast studies of their upper limb venous systems were examined for location of the SVC-RA in relation to a radiographic landmark.
Results:
Most patients (92.5%) showed the SVC-RA junction to lie at the sixth thoracic vertebral level or the interspace above or below. The SVC-RA junction lay lower than the right main bronchus and the notch on the right cardiomediastinal contour.
Conclusion:
The vertebral body provides a useful and radiographically visible landmark for accurate central catheter tip placement.
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