Lee Ji-Hyun, Byon Hyo-Jin, Choi Yoon-Hyeong, Song In-Kyung, Kim Jin-Tae, Kim Hee-Soo
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Paediatr Anaesth. 2017 Dec;27(12):1220-1226. doi: 10.1111/pan.13258. Epub 2017 Oct 17.
Few reports exist regarding the optimal depth of a left-sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight.
A two-stage study was conducted. In the first observational study, infants aged ≤1 year and scheduled for elective surgery requiring a central venous catheter were enrolled. The tip of the central venous catheter was confirmed using transthoracic echocardiography. Linear regression modeling was performed to determine the association between the insertion depth of the central venous catheter and the I-A-B distance (I, the insertion point; A, the sternal head of the left clavicle; B, the midpoint of the perpendicular line drawn between the sternal head of the right clavicle and an imaginary line between the nipples), based on age, height, and weight. In the second study, the results of the first study were validated in another group of consecutive infants.
In the first study, the data of 67 patients were analyzed. The infant's height and I-A-B distance were highly correlated with the level of the central venous catheter tip (R =0.763 and 0.772, respectively; all P < .01), using the regression equations 0.11 × height (cm) + 0.19 and 1.02 × I-A-B (cm) + 1.55, respectively. In the second study, height was also highly correlated with the insertion depth of the central venous catheter in another 42 infants (r = .938, P = <.001). In a Bland-Altman's analysis, the mean bias and precision of the actual insertion depth and predicted depth using height were 0.09 and 0.15 cm, respectively. The limits of agreement were -0.19 and 0.38 cm, respectively.
In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.
关于小儿患者左侧中心静脉导管的最佳深度，相关报道较少。我们旨在利用解剖标志、年龄、身高和体重，为婴儿左颈内静脉中心静脉导管的最佳深度提供指导。
进行了一项两阶段研究。在第一项观察性研究中，纳入年龄≤1岁且计划进行需要中心静脉导管的择期手术的婴儿。使用经胸超声心动图确认中心静脉导管的尖端位置。基于年龄、身高和体重，进行线性回归建模，以确定中心静脉导管插入深度与I-A-B距离（I为插入点；A为左锁骨胸骨端；B为右锁骨胸骨端与乳头间假想线的垂线中点）之间的关联。在第二项研究中，在另一组连续的婴儿中验证了第一项研究的结果。
在第一项研究中，分析了67例患者的数据。婴儿的身高和I-A-B距离与中心静脉导管尖端位置高度相关（R分别为0.763和0.772；均P <.01），回归方程分别为0.11×身高（cm）+ 0.19和1.02×I-A-B（cm）+ 1.55。在第二项研究中，身高与另外42例婴儿的中心静脉导管插入深度也高度相关（r =.938，P =<.001）。在Bland-Altman分析中，实际插入深度与使用身高预测深度的平均偏差和精密度分别为0.09和0.15 cm。一致性界限分别为-0.19和0.38 cm。
在婴儿中，可使用一个基于身高的简单公式来确定左颈内静脉中心静脉导管的最佳深度。
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