Optimizing Pediatric Tunneled Central Venous Catheter Placement: A Height-Based Approach for Precise Length...

Central venous access (CVA) is an integral part of the management of various pediatric diseases. One of the commonly used CVAs is subcutaneous ports (SP). The adequate catheter tip location has been described ideally to be placed at the junction of the superior vena cava and right atrium (known as Cavo-atrial junction (CAJ)) confirmed by intraoperative fluoroscopy. In the pediatric population, the intravascular catheter length estimation is challenging due to the wide variance in body habitus and it is very important to properly place the CVC to eliminate the risk of complication. Our study aims at accomplishing an accurate formula to preoperatively predict the CVA length based on the insertion site and patient's height.

This is a prospective study including 134 patients less than 21 years old who underwent placement of SP at St Jude Children's Research Hospital during the period from August 2022 to July 2023, either using the right internal jugular vein (RIJV) or left subclavian veins (LSCV). The intravascular catheter length (in cm) was measured using the grading on the catheter lines. Formulas were developed using the line measurement and patient height for each of the techniques, and the formulas were compared to previously published formulas. These formulas were tested to validate their reliability and accuracy.

The formula developed for the RIJV demonstrated a predictive accuracy within 1 cm for 50% of the CVCs, while that for the LSCV notably surpassed existing methods, achieving a high prediction within 1 cm for 71.5% of CVCs.

Pediatric intravascular CVC length can be estimated by formulas suggested by the present study based on the insertion side and patient height, limiting x-ray exposure during CVC insertion and decreasing potential complications.

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