• Gaku Inagawa, Koui Ka, Yukichi Tanaka, Keisuke Kato, Mio Tanaka, Takaaki Miwa, Naoto Morimura, Yukihide Koyama, and Koichi Hiroki.
• Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan. inagawa@med.yokohama-cu.ac.jp
• Paediatr Anaesth. 2007 Oct 1;17(10):968-71.

BackgroundCardiac tamponade is rare but one of the most serious complications in relation to central venous catheters (CVC). The tip of the CVC should be placed outside the pericardium to avoid tamponade. In adults, the carina is always located above the pericardium; therefore, the carina is a reliable landmark for CVC placement. We examined whether the carina could also be an adequate landmark for CVC placement in neonates.MethodsThe study was conducted using nine fresh neonatal cadavers. The longitudinal distance between the carina and the pericardium as it transverses the superior vena cava (the pericardial reflection: PR) was measured.ResultsThe median postconceptional age (gestational age in weeks + weeks after delivery) at autopsy was 35 (range: 23-42) weeks. The PR was located at a distance of 4 mm above to 5 mm below the carina. Unlike in adults, the position of the PR varies in relation to the carina in neonates. In seven of the nine subjects, the location of the PR was above the carina.ConclusionsIn neonates, the carina is not always located above the pericardium, as it is in adults; therefore, the carina is not an appropriate landmark for CVC placement.

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