• Tiberiu Ezri, Marian Weisenberg, Daniel I Sessler, Haim Berkenstadt, Sorin Elias, Peter Szmuk, Francis Serour, and Shmuel Evron.
• Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel.
• J. Cardiothorac. Vasc. Anesth. 2007 Aug 1;21(4):497-501.

ObjectiveRadiographically, a central venous catheter (CVC) tip should lie at the level of the right tracheobronchial angle. Precalculation of length of CVC insertion may avoid unnecessary catheter malposition. The purpose of this study was to assess the accuracy of a method of CVC positioning, based on external topographic landmarks.DesignA prospective, randomized study.SettingUniversity-affiliated hospital, single institution.ParticipantsPatients scheduled for surgery.InterventionsPatients were allocated for insertion of the catheter through the right internal jugular vein to either a fixed, predetermined, 15-cm length (n = 50) or to a depth calculated topographically (n = 50) by drawing a line from the level of the thyroid notch to the sternal manubrium. The catheter was repositioned if its tip was situated >5 cm above the carina or >1 cm below it. The distance from the catheter tip to the carina was measured. The main study endpoint was the need for catheter repositioning.Measurements And Main ResultsTwo percent of patients required repositioning in the topographic group compared with 78% in the 15-cm length group (p < 0.001). No patient in the topographic group and 10 patients (20%) in the 15-cm group had the catheter placed in the right atrium (p < 0.05). The mean distance from the CVC tip to the carina was 2.9 +/- 1.4 cm above the carina in the topographic group and 1.9 +/- 1.1 cm below the carina in the 15-cm length group (p < 0.001). No patient had a too proximally placed catheter. Insertion lengths in the topographic group ranged between 9 and 12.5 cm.ConclusionsIt is recommended to use the topographic approach in deciding CVC depth with right internal jugular CVC placement.

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