PRECANNULATION OF CENTRAL VENOUS CATHETER INSERTION DEPTH IN RIGHT SUBCLAVIAN VEIN BASED ON ANATOMICAL LANDMARKS AVOIDING THE RIGHT ATRIUM

Dr Deepak Bhasin; Dr Vandana Chugh; Dr Rajshree Sharma; Dr U Naga Satish

Volume : VII, Issue : IX, September - 2018

PRECANNULATION OF CENTRAL VENOUS CATHETER INSERTION DEPTH IN RIGHT SUBCLAVIAN VEIN BASED ON ANATOMICAL LANDMARKS AVOIDING THE RIGHT ATRIUM

Dr Deepak Bhasin, Dr Vandana Chugh, Dr Rajshree Sharma, Dr U Naga Satish

Abstract :

Introduction–Central venous cannulation(CVC) is a common procedure in intensive care units, operation rooms and emergency wards .CVC is done through various routes and subclavian vein cannulation through infraclavicular route is very common. The present study was to evaluate the anatomical landmark technique of precalculation of CVC insertion depth using the thyro–sternal distance against the conventional insertion depth of 15 cms thru the right SCV with regard to the need for catheter repositioning and incidence of complications related to catheter tip malposition.

MethodA total of 100 patients were randomly selected and grouped into the thyro–sternal distance group (Group T) and the 15 cms insertion depth group (Group C) of each 50 patients. The operator who inserted the catheter was an experienced anaesthesiologist.

The study compared various variables like age, sex, height and the thyro–sternal distance. The following observations are madeduring the procedsure namely, the catheter tip to carina distance on the post procedure Chest X–ray and the need for catheter repositioning due to catheter tip malposition.The results were analysed by computing the statistics viz. mean, standard deviation, standard error of mean and P–value was tested using the unpaired student t–test and chi–square test.

Results–In Group T the TSD mean was 12.32±1.34 cms and in Group C the mean TSD was 12.52±1.28 cms.In Group T the average depth of insertion is 12.32±1.34 cms, with female having a lower mean insertion depth of 11.88 cms than males who had a mean insertion depth of 12.76 cms. In group C the mean insertion depth of all patients is 15 ±0 cms. (P<0.01).In the test Group T the mean T–C distance is 0.75±1.17 cms above the carina with the distance safer in females with a mean of 1.01±0.96 cms above the carina than in males with a mean of 0.49±1.32 cms above the carina.In the control Group C, where the insertion depth was fixed at the standard 15 cms the mean T–C distance was 0.87 ±1.06 cms below the carina with the tip dangerously close to the pericardial reflection in female with an average distance of 1.27±0.82 cms below the carina than in males whose average distance was 0.52±1.12 cms below the carina.In the test Group T total 2(4%) patients needed repositioning of the catheters due to too deep placement of the catheter which was far less when compared to the control Group C where a total of 16 (32%) patients needed repositioning of catheters

Conclusions– Central venous cannulation through subclavian route, using the thyro–sternal distance leads to lesser insertion depths than the conventional depth of insertion of 15 cms and the incidence of complications and need for catheter repositioning is greatly reduced .