Bedside Prediction of Correct Length of Right Internal Jugular Venous Catheters Based on Anatomical Land Marks
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 10
Abstract
Background: Correct positioning of the central venous catheter tip near or at the junction of the superior vena cava and right atrium is necessary for better monitoring and avoid complications.The anatomical landmark method is a simpler, cost effective, and performed at bedside, thereby facilitating safe positioning of the CVC tip. Therefore this study was conducted to compare the accuracy of the two method of central venous catheter positioning based on anatomical landmarks and Trans Eosophageal Echography. Methods: After obtaining approval of hospital ethical committee and informed written consent 200 adult patients of either sex scheduled to undergo cardiac surgery were randomly allocated to Group 1,(Anatomical landmark) and Group 2 (Trans-esophageal echo-cardiography group) . The right internal jugular vein was cannulated to a depth calculated from apex of the sternocleidomastoid triangle and the junction of superior and middle one third of the manubrium and under the guidance of trans-esophageal echo-cardiography till SVC-RA junction respectively. The catheter was identified on TEE by Saline flush test. Catheter tip was considered acceptable up to 10mm to SVC –RA junction in both the groups on TEE. Results: The power of study was 80% and level of significance as 0.05.The two groups were matched. The average length of catheter inserted in anatomical landmark group was 10.36± 1.34 cm and in TEE group was at 10.90± 0.96 cm (p-value < 0.05).65% of catheter had correct placement of tip by anatomical landmark as assessed by TEE (p value <0.001). Out of 65, 40 had tip placed above SVC-RA junction with the mean distance 6.785 ± 1.78 mm and 4 had tip placed below the SVC-RA junction with the mean distance 7.75 ±2.87 mm and 21 tip was positioned at the SVC-RA junction on TEE.TEE guided catheter insertion resulted in 100% correct placement. Conclusion: In our study we found that the anatomical landmark method is 65% accurate compared to TEE guided central venous catheter insertion. At the bedside, in an emergency situation where vascular access takes priority, anatomical landmark method can be safely practiced to insert central venous catheter to an appropriate depth.
Authors and Affiliations
Col V S Joshi
Keywords
Related Articles
- EP ID EP528913
- DOI -
- Views 43
- Downloads 0
Mystery of Auto-Haemotherapy
Auto-haemotherapy is the mystery that medicine had missed in the past. It is the power that can stimulate the immune system of the body in order to re-adjust all the body’s functions including the endocrinologial system,...
Anterior Esthetic Crown Lengthening Surgical Procedure
The aim of this case report was to describe the surgical sequence of crown lengthening. Many different causes can be responsible for short clinical crown. In our case, the gingival overgrowth is the case that producing s...
Assessing the Prognostic Significance of Fuhrman Grading in Renal Cell Carcinoma by Comparing with Morphological Prognostic Factors
Back ground – Renal cell carcinoma is a disease of varying prognosis. We evaluated the prognostic significance of Fuhrman nuclear grade by comparing with various morphological parameters which are considered to be indepe...
Prospective study for the evaluation of etiology of posterior capsular opacification formation in patients after cataract surgery
Background: Posterior capsular opacification (PCO) is the most common late complication of cataract surgery. Once PCO start covering pupillary area patient complain of blurry vision. This can be treated by using laser or...
Domestic Violence, Cause and Consequences on Pregnancy
Domestic violence is a preventable global public health and human rights issue which affects millions of women regardless of age, economic status, race, religion, ethnicity, or educational background worldwide. Women who...