Hsu J H, Wang S S, Lu D V, Cheng K I, Wang C K, Wu J R
Department of Paediatrics, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan.
Anaesthesia. 2007 Aug;62(8):818-23. doi: 10.1111/j.1365-2044.2007.05139.x.
We compared four different skin surface landmarks, the lower margin of the right 2nd costo-sternal junction (point A); the upper margin of the right 3rd costo-sternal junction (point B); the lower margin of the right 3rd costo-sternal junction (point C); and a point 5 cm below the manubrio-sternal junction (point D), in 20 cancer patients undergoing insertion of permanent central venous catheters whose tips were placed near the superior vena cava - right atrium (SVC-RA) junction under transoesophageal echocardiography guidance. The landmark was satisfactory if it was located within 1 cm of the SVC-RA junction. Points C and D were closer to the SVC-RA junction than points A and B (p < 0.0001). However, point C had the highest incidence (C: 70%, A: 0%, B: 20%, D: 30%, p < 0.0001) of being within 1 cm of the SVC-RA junction.