Formulas for Prediction of Insertion Depths of Internal Jugular Vein Catheters Adjusted to Body Height Categories

Abstract

Purpose

Whether formulas for prediction of central venous catheter (CVC) insertion depths have different applicability in patients with different body heights is not known. Goal of study was to test formulas for catheterizations of internal jugular veins (IJVs) in a population of different body height classes with correct CVC tip positions.

Methods

Consecutive adult patients requiring CVC for cardiac surgery were enrolled and those with tip positions at the junction of the superior vena cava and the right atrium ±1 cm underwent formula analysis. Precision of formula prediction was calculated for three classes of body height.

Results

Of the 635 included patients, 254 underwent right IJV catheterization and 381 underwent left IJV catheterization, respectively. Formula-guided approach for both right [formulas (height/10) (in cm) and (height/10) −1 (in cm)] and left [formula (height/10) + 4 (in cm)] IJV CVC was more precise in patients with a body height of 170-180 cm compared with patients with a body height <170 cm (who required deeper insertion than predicted by formula) and patients with a body height >180 cm (who required a more proximal insertion than predicted by formula).

Conclusions

Independent from body height classes, all formulas calculated a relatively low likelihood of atrial positions but high risks of proximal mal-positioning. Thus, considering inter-individual differences of vascular anatomy and for safety reasons, formulas cannot be recommended.

Keywords

Central venous catheter Internal jugular vein Insertion depth Formula

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References

Vesely

T.M.

Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol. 2003; 14 (5): 527–534.

Liu

P.T.

, Samson

, Maurellet

J.D.

, Manthous

Insertion of the dialysis catheter into right atrium or superior vena cava?

Clin Nephrol. 2011; 75 (3): 269–270.

McGee

D.C.

, Gould

M.K.

Preventing complications of central venous catheterization. N Engl J Med. 2003; 348 (12): 1123–1133.

Frykholm P, Pikwer A, Hammarskjöld F, et al; Swedish Society of Anaesthesiology and Intensive Care Medicine. Clinical guidelines on central venous catheterisation. Acta Anaesthesiol Scand. 2014; 58 (5): 508–524.

Walshe

, Phelan

, Bourke

, Buggy

Vascular erosion by central venous catheters used for total parenteral nutrition. Intensive Care Med. 2007; 33 (3): 534–537.

Gravenstein

, Blackshear

R.H.

In vitro evaluation of relative perforating potential of central venous catheters: comparison of materials, selected models, number of lumens, and angles of incidence to simulated membrane. J Clin Monit. 1991; 7 (1): 1–6.

Peres

P.W.

Positioning central venous catheters—a prospective survey. Anaesth Intensive Care. 1990; 18 (4): 536–539.

Czepizak

C.A.

, O'Callaghan

J.M.

, Venus

Evaluation of formulas for optimal positioning of central venous catheters. Chest. 1995; 107 (6): 1662–1664.

Pérez Valdivieso

J.R.

, Mbongo Bubakala

, Honorato Cía

, Monedero Rodriguez

[Evaluation of a formula for optimal positioning of a central venous catheter through the right internal jugular vein]. Rev Esp Anestesiol Reanim. 2003; 50 (2): 77–79.

10.

Joshi

A.M.

, Bhosale

G.P.

, Parikh

G.P.

, Shah

V.R.

Optimal positioning of right-sided internal jugular venous catheters: comparison of intra-atrial electrocardiography versus Peres' formula. Indian J Crit Care Med. 2008; 12 (1): 10–14.

11.

Pan

P.P.

, Engstrom

B.I.

, Lungren

M.P.

, Seaman

D.M.

, Lessne

M.L.

, Kim

C.Y.

Impact of phase of respiration on central venous catheter tip position. J Vasc Access. 2013; 14 (4): 383–387.

12.

Morgan

, Ho

, Murray

, Davies

, Louw

A randomized trial of catheters of different lengths to achieve right atrium versus superior vena cava placement for continuous renal replacement therapy. Am J Kidney Dis. 2012; 60 (2): 272–279.