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Updated: Oct 21, 2026
The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire
Published on: December 23, 2014
Development and temporal validation of a simple CT-based body surface landmark approach for optimising central venous
Tatsuya Kida1, Masakazu Sumitomo
1From the Departments of Anaestheesiology, Yokosuka Kyosai Hospital, Yokosuka, Japan (TK, MS).
Background:
Accurate positioning of central venous catheter (CVC) tips is essential to avoid complications, yet consistent appropriate placement within the superior vena cava remains challenging without a simple method for depth adjustment.
Objectives:
To develop and temporally validate a simple computed tomography-based (CT-based) body surface landmark approach for estimating optimal insertion depth (OID) and to assess its impact on appropriate catheter tip positioning.
Design:
Single-centre prospective observational cohort study.
Setting:
Tertiary care hospital in Japan; February 2017 to June 2019.
Patients:
Adult patients undergoing surgery requiring CVC placement via the right internal jugular vein with preoperative chest CT. After exclusions, 86 patients were included in the derivation cohort and 100 in the validation cohort.
Intervention:
In the derivation cohort, insertion depth was determined by the attending anaesthesiologist; in the validation cohort, it was determined using a model derived from the derivation cohort.
Main Outcome Measure:
The primary outcome was the proportion of appropriately placed catheter tips.
Results:
The final model retained the insertion point-to-body surface landmark distance (ILD), defined using a body surface landmark corresponding to the CT-identified midpoint of Zone B, as the sole predictor: OID (cm) = 0.64 × ILD + 3.64. The proportion of appropriately placed catheter tips was higher in the validation cohort than in the derivation cohort (92.0% (95% CI, 85.0 to 95.9%) vs. 73.3% (95% CI, 63.1 to 81.5%); P < 0.001). Model-guided placement was associated with increased likelihood of appropriate positioning (adjusted odds ratio 4.68 (95% CI, 1.97 to 12.27)). Model performance showed good calibration and moderate explanatory ability (R2 approximately 50%) in both cohorts.
Conslusions:
A CT-based body surface landmark approach was associated with improved consistency of appropriate CVC tip placement and enables patient-specific estimation of insertion depth.
Trial Registry:
UMIN Clinical Trials Registry (UMIN000026252).
