Measuring central venous structures in humans: implications for central-vein catheter dimensions

The tip of a central vein catheter for hemodialysis should be located in the upper right atrium for the best performance. Hemodialysis catheters do have internal diameter unadjusted to the catheter length; however, the longer the catheter the slower the flow at the same pressure difference. On the other hand, the catheter diameter cannot be so large as to fill the vein too tightly as it predisposes to the damage of the vein wall, thrombosis and stenosis. Therefore, the catheter length and diameter should be appropriate for the patient. For this purpose, the exact dimensions of the venous system in vivo should be known. In this study we correlated the anthropometric measurements and the dimensions of the large upper body veins in 31 adult volunteers. After deep inspiration, magnetic resonance imaging of the chest was performed in three planes; the positions of specific points in the three-dimensional coordinate system were measured, and the distance to adjacent points was calculated according to the analytic geometry formula. The total length from the catheter entry point to the right atrium was the sum of distances between the adjacent points. The lengths of the veins were correlated with the body anthropometric measurements (height, weight, body surface area, bi-acromion span, and height plus bi-acromion span). The best overall correlations of the lengths and diameters of the large upper body veins are with the body surface area. A table is included to guide the selection of the total catheter length and diameter in relation to the body surface area and insertion site.