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Height-based formulas for predicting intravascular length of tunnelled neck central venous catheter in paediatric
H Y Lo1, K F K Fung2, F Yam3
1Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR, China. hongyiplo@gmail.com.
Insights
Simple formulas predict central venous catheter (CVC) length in children, reducing radiation exposure. These height-based formulas accurately estimate CVC intravascular length for common insertion sites.
Area of Science:
- Pediatric Interventional Radiology
- Medical Device Engineering
- Radiological Safety
Background:
- Central venous catheter (CVC) placement is a frequent pediatric procedure.
- Minimizing radiation exposure during CVC insertion is crucial for patient safety.
Purpose of the Study:
- To develop simple, accurate formulas for predicting CVC intravascular length in children.
- To reduce the need for intra-procedural imaging, thereby minimizing radiation exposure.
Main Methods:
- Retrospective review of 124 pediatric patients undergoing tunnelled neck CVC placement and CT.
- Development of linear regression formulas based on patient height and CVC insertion site (REJV, RIJV, LEJV, LIJV).
- Validation of REJV and RIJV formulas using independent cohorts.
Main Results:
- Formulas demonstrated a high goodness-of-fit (R^2 > 0.8).
- REJV formula predicted length within 1 cm in 70% of cases (mean absolute difference 0.63 cm).
- RIJV formula predicted length within 1 cm in 80% of cases (mean absolute difference 0.67 cm).
Conclusions:
- Simple formulas based on height and insertion site can reliably estimate pediatric CVC intravascular length.
- Further prospective validation is recommended for LEJV and LIJV formulas.
Introduction:
Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure.
Methods:
124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children's Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites-9 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes.
Result:
The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1 cm in 70% of CVC with mean absolute difference of 0.63 cm (SD 0.48 cm), and the RIJV formula was predictive of intravascular CVC length within 1 cm in 80% of CVC with mean absolute difference of 0.67 cm (SD 0.53 cm).
Conclusion:
Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.
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