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Published on: December 23, 2014
Fourth thoracic vertebra as landmark for depth of right internal jugular vein catheterization in infants
Guoliang Liu1, Jianmin Zhang1, Fang Wang2
1Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China.
Insights
The fourth thoracic vertebra can serve as a reliable radiographic landmark for infant internal jugular vein catheterization depth, improving central venous catheter placement accuracy.
Area of Science:
- Pediatric Anesthesiology
- Radiology
- Vascular Access
Background:
- The carina is a known landmark for internal jugular vein catheterization depth in infants.
- The relationship between the infant carina and vertebral bodies is not well-established.
- Identifying reliable radiographic landmarks is crucial for safe central venous catheter placement.
Purpose of the Study:
- To evaluate the positional relationship between the infant carina and thoracic vertebrae.
- To determine if vertebral bodies can serve as radiographic landmarks for internal jugular vein catheterization depth.
Main Methods:
- Retrospective analysis of 108 infants (1-12 months) undergoing congenital heart surgery.
- Analysis of post-operative chest radiographs for infants with right internal jugular vein catheterization.
- Assessment of the positional relationship between the carina and vertebral bodies, measuring central venous catheter (CVC) tip distance from the carina.
Main Results:
- The carina was located at the fourth thoracic vertebra in 98% of cases.
- The fourth thoracic vertebra was at the same level as the carina in most infants.
- 6.3% of cases had CVC tips more than 22 mm below the carina, potentially near the right atrium.
Conclusions:
- The fourth thoracic vertebra is a consistent radiographic landmark for the carina in infants.
- This finding offers a potential alternative landmark for guiding internal jugular vein catheterization depth.
- Utilizing the fourth thoracic vertebra may improve the accuracy and safety of central venous catheter placement in infants.
Abstract:
The carina is considered a reliable marker for the depth of right internal jugular vein catheterization in infants on chest radiograph. In adult anatomy, the carina is typically located at the level of the fifth thoracic vertebra. We are not aware of a positional relationship between infant carina and thoracic vertebrae. Thus, we evaluated that a vertebral body may be at the same level as carina and can be as radiographic landmarks for the depth of right internal jugular vein catheterization in infants. In this retrospective analysis, 108 infants (aged 1-12 months) who underwent congenital heart surgery between January 1, 2019 and June 30, 2019 were included. We analyzed the post-operative chest radiographs of those who underwent right internal jugular vein catheterization and assessed the positional relationship of the carina and vertebral bodies. We measured the vertical distance of the central venous catheter (CVC) catheter tip from the carina (below the carina 22 mm, it may be close to or into the right atrium). In total, 95 children were enrolled; The carina was located at the third thoracic vertebra in two cases (2%) and at the fourth thoracic vertebra in 93 cases (98%). The distance between the tip of CVC and the carina was 10 (4, 15) mm, and 6.3% (6 cases) had the catheter tip at more than 22 mm below the carina. Most fourth thoracic vertebrae were at the same level as the carina on chest radiographs. Therefore, it has potential as a radiographic landmark for the depth of right internal jugular vein catheterization in infants on chest radiograph.
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