Shin Hyun-Jung, Kim Byung Gun, Na Hyo-Seok, Oh Ah-Young, Park Hee-Pyoung, Jeon Young-Tae
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonngi-do, 463-707, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
J Anesth. 2015 Oct;29(5):724-7. doi: 10.1007/s00540-015-2012-1. Epub 2015 Apr 16.
Several methods have been used to predict the optimal depth of central venous catheter (CVC) tip position when using the anatomical landmark technique. In the present study, we devised a simple formula to predict CVC depth using ultrasound images and chest X-ray (CXR) in patients undergoing ultrasound-guided subclavian venous catheterization.
Central venous catheterization via the subclavian vein was performed under ultrasound guidance. We measured five parameters to determine the distance between the needle insertion point and the CVC tip: insertion point to vein puncture point (A), insertion point to a skin point indicating a vertical position above the vein puncture point (B), insertion point to the clavicular notch (C), clavicular notch to the carina (D), and catheter tip to carina (E). Catheter insertion depth was then determined as follows: calculated catheter insertion depth = A - B + C + D; actual catheter insertion depth = (A - B + C + D) + E.
The calculated CVC insertion depth (mean ± SD) was 15.4 ± 1.5 cm from the needle insertion point to the carina [95 % confidence interval (CI) 15.0-15.9 cm]. Actual depth was 15.4 ± 1.5 cm (95 % CI 15.0-15.9 cm). No significant difference was observed between the calculated CVC insertion depth and the actual distance from the needle insertion point to the carina (p = 0.940).
The appropriate length of a CVC inserted through the subclavian vein can be estimated by a formula using ultrasound images and CXR.
在使用解剖标志技术时，已经采用了多种方法来预测中心静脉导管（CVC）尖端位置的最佳深度。在本研究中，我们设计了一个简单的公式，用于在接受超声引导下锁骨下静脉置管的患者中，利用超声图像和胸部X线（CXR）来预测CVC深度。
在超声引导下经锁骨下静脉进行中心静脉置管。我们测量了五个参数以确定针插入点与CVC尖端之间的距离：插入点至静脉穿刺点（A）、插入点至静脉穿刺点上方垂直位置的皮肤点（B）、插入点至锁骨切迹（C）、锁骨切迹至隆突（D）以及导管尖端至隆突（E）。然后按以下方式确定导管插入深度：计算的导管插入深度 = A - B + C + D；实际导管插入深度 =（A - B + C + D）+ E。
从针插入点至隆突的计算CVC插入深度（均值±标准差）为15.4±1.5 cm[95%置信区间（CI）15.0 - 15.9 cm]。实际深度为15.4±1.5 cm（95%CI 15.0 - 15.9 cm）。计算的CVC插入深度与从针插入点至隆突的实际距离之间未观察到显著差异（p = 0.940）。
通过使用超声图像和CXR的公式，可以估算经锁骨下静脉插入的CVC的合适长度。
