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The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Optimal insertion depth of subclavian vein catheterization via the right supraclavicular approach in children
Ping Ye1, Yanzhe Tan1, Shujun Shi1
1Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
A modified formula accurately determines subclavian vein (SCV) catheterization depth in children under 6 years old. This ultrasound-guided technique improves central venous access safety and reliability.
Area of Science:
- Pediatric Anesthesiology
- Vascular Access Procedures
- Medical Device Technology
Background:
- Determining optimal insertion depth for ultrasound-guided supraclavicular subclavian vein (SCV) catheterization in children is challenging.
- Current methods lack definitive guidelines, leading to variability in practice.
Purpose of the Study:
- To evaluate the accuracy and reliability of a modified surface landmark formula for calculating SCV catheter insertion depth in pediatric patients.
- To establish a safer and more precise method for central venous catheter placement in young children.
Main Methods:
- A prospective observational study involving 36 children (age <6 years, weight ≥5 kg) undergoing congenital heart surgery.
- Ultrasound-guided supraclavicular SCV catheterization was performed post-intubation.
- Actual catheter depth was confirmed using transesophageal echocardiography; a modified formula was used for depth calculation.
Main Results:
- A strong correlation (r = .806) was found between the calculated and actual SCV catheter insertion depths.
- Bland-Altman analysis indicated a mean bias of 0.36 cm and precision of 0.65 cm, with no instances of catheter tips in the right atrium.
- The modified formula demonstrated high reliability for determining appropriate catheter depth.
Conclusions:
- A modified surface landmark formula provides a reliable method for calculating optimal insertion depth in ultrasound-guided supraclavicular SCV catheterization for children.
- This technique is suitable for children younger than 6 years and weighing over 5 kg.
- The findings contribute to safer and more accurate central venous access in pediatric patients.
Background:
Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children.
Aim:
We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children.
Methods:
This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound-guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real-time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples.
Results:
Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = .806, 95% confidence interval [CI]: 0.658-0.908; p < .001). Bland-Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14-0.58, 95% limits of agreement: -0.92, 1.64). All plots were above the -1.0 line, indicating no catheter tip insertion into the right atrium.
Conclusions:
Optimal insertion depth for an ultrasound-guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.
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