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Published on: July 13, 2019
[Correct positioning of central venous catheters in pediatrics : Are current formulae really useful?]
C Cleff1, M Boensch2, F Eifinger3
1Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland. corvin.cleff@uk-koeln.de.
Insights
Formulas for central venous catheter (CVC) insertion depth in children have limited practical benefit. Correct CVC tip positioning is crucial to prevent complications, and imaging verification is recommended.
Area of Science:
- Pediatric critical care medicine
- Vascular access procedures
- Medical device safety
Background:
- Accurate central venous catheter (CVC) tip placement in pediatric patients is critical.
- Malpositioned CVCs increase risks of arrhythmia, thrombosis, infection, and tamponade.
Purpose of the Study:
- To review and summarize existing formulas for pediatric CVC tip positioning.
- To evaluate the utility of these formulas in clinical practice.
Main Methods:
- Systematic literature search of Medline and PubMed for CVC insertion depth formulas.
- Keywords included "pediatric," "central venous catheter," "formula," and "insertion depth."
- Analysis of 127 publications from 854 identified articles.
Main Results:
- Six publications presented height-based formulas for CVC insertion depth.
- No prospective studies validated the efficacy of these formulas for optimal CVC tip placement.
- The practical benefit of formulas is limited by challenges in selecting the correct insertion site.
Conclusions:
- Formulas for CVC insertion depth offer limited value in daily pediatric practice.
- Recommended insertion depths should serve as guidelines.
- Imaging techniques are essential for verifying correct CVC tip position.
Background:
Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade.
Objective:
The aim of this review was to identify and summarize published formulae for the correct positioning of the CVC tip in children and to discuss the benefits of these formulae for the daily routine.
Material And Methods:
A systematic and standardized search in Medline and PubMed was performed to identify published formulae. Formulae for insertion depth of the CVC tip over the right internal jugular vein are discussed. The keywords "pediatric" or "pediatric", "children", "central venous catheter", "CVC", "central venous", "length", "insertion", "optimal", "formula", "depth", "correct position" and "right position", "internal jugular vein" were used to identify the formulae.
Results:
A total of 854 publications were found and 127 publications were analyzed. The publications were subsequently assessed and classified independently by a specialist in anesthesiology and a specialist in pediatrics. A total of six publications described different body height-based formulae for calculation of a CVC insertion depth. No prospective evaluation of these formulae was performed to show if it is possible to place a CVC tip at the optimal position.
Conclusion:
The benefit of a formula for daily practice is very limited due to the problem of choosing the right insertion point. The recommended insertion depth should be considered as an indicator and a verification of the CVC tip position should be done using an imaging technique.
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