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Updated: Jan 19, 2026
Catheter Insertion in Internal Jugular: the Seldinger Technique
Published on: April 30, 2023
Using sternal angle as anatomic landmark for right internal jugular vein catheterization in pediatrics
Hui Xu1, Xiaoqiu Zhu1, Jin Li1
1Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Insights
The sternal angle provides a reliable landmark for accurate central venous catheter (CVC) placement in children. This method ensures safe positioning, especially in emergency situations when other measurements are unavailable.
Area of Science:
- Pediatric critical care medicine
- Vascular access procedures
- Anatomical landmark utilization
Background:
- Traditional formulas for central venous catheter (CVC) depth in children rely on height, weight, and age, which may be unavailable in emergencies.
- The need for direct, reliable methods to guide CVC placement in pediatric patients is critical.
Purpose of the Study:
- To evaluate the efficacy and safety of using the sternal angle as an anatomical landmark for guiding central venous catheter (CVC) tip positioning in children.
- To establish a direct method for CVC placement in pediatric patients, particularly in emergency settings.
Main Methods:
- A prospective study involving 75 pediatric patients (aged 1-10 years) undergoing CVC insertion via the right internal jugular vein.
- Catheter depth was determined by measuring the distance from the skin puncture site to the sternal angle plane, with a 1 cm subtraction.
- Post-insertion chest radiography confirmed catheter tip position relative to the carina.
Main Results:
- All 75 central venous catheters were successfully positioned above the carina.
- The average distance from the catheter tip to the carina was 9.8 mm.
- No serious complications were reported in the study cohort.
Conclusions:
- The sternal angle is a practical and dependable anatomical landmark for guiding central venous catheter (CVC) placement in pediatric patients.
- This technique allows for rapid and safe CVC positioning in the right internal jugular vein, proving particularly valuable in emergency scenarios.
Background:
Many formulas based on the patient's height, weight and/or age exist to determine central venous catheter (CVC) depth in children. However, this information is unavailable in some emergency conditions. Therefore, direct methods should be developed to guide catheter position in children.
Methods:
Eighty patients aged 1-10 y were enrolled from July 2015 to August 2016 and seventy-five were completed; fifty were male, and twenty-five were female. The exclusion criteria were inability to identify the sternal angle or failure to use the right internal jugular vein approach. The catheter was inserted using the right internal jugular vein approach, the distance from the skin puncture point to the midpoint of the sternal angle plane was measured, and the catheter tip was positioned to this distance minus 1 cm. Chest radiography were performed for those children after catheter insertion. The relative position between the catheter tip and carina was confirmed and the longitudinal distance from the catheter tip to the carina was calculated on radiographic images, and related complications were recorded.
Results:
All catheter tips were above the carina, and the average distance from the catheter tip to the carina was 9.8 mm. No patients experienced serious complications.
Conclusion:
The sternal angle is a useful and reliable anatomic landmark for guiding CVC position in children. Using this landmark, the catheter can be quickly and conveniently placed at a safety position in right internal jugular vein, especially in some emergency conditions.
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