Yamamoto Tomohiro, Schindler Ehrenfried
Department of Pediatric Anesthesiology and Critical Care Medicine, German Pediatric Heart Center/Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany.
Paediatr Anaesth. 2019 Apr;29(4):368-376. doi: 10.1111/pan.13614. Epub 2019 Mar 13.
Several formulae or methods are reported to predict the ideal central venous catheter insertion depth. However, they are complicated and often unsuitable in cases requiring rapid management.
This study aimed to determine a simple and practical method to predict the ideal central venous catheter insertion depth after the real-time ultrasound-guided right internal jugular vein, or left or right supraclavicular approach in pediatric patients.
Pediatric patients with congenital heart diseases who underwent cardiovascular surgery between July 2015 and February 2018 in the German Pediatric Heart Center Sankt Augustin were enrolled. Body height, body weight, patient age (months), and central venous catheter insertion depth were retrieved from the anesthesia records. Ideal central venous catheter insertion depth was calculated by measuring the distance between the level of the carina tracheae and the central venous catheter tip on the first postoperative chest radiograph. The relationships of body height, body weight, and patient age (months) to ideal central venous catheter insertion depth for the right internal jugular, left supraclavicular, and right supraclavicular approaches were investigated.
Body height was the best parameter, providing the best coefficients of determination as well as the simplest relationship. Based on analysis for ideal central venous catheter insertion depth for every 10-cm increase in body height, there was an ideal central venous catheter insertion depth for each body height, independent of the anesthesiologist's experience with the approach used. Whereas ideal central venous catheter insertion depths for the right internal jugular vein approach and the left supraclavicular approach showed no significant difference, ideal central venous catheter insertion depth for the right supraclavicular approach was significantly shorter than that of the other two approaches.
This study successfully determined a visually simple and practical bar graph to predict the ideal central venous catheter depth inserted using only the real-time ultrasound-guided insertion technique for the right internal jugular vein, left supraclavicular, and right supraclavicular approaches.
有几种公式或方法可用于预测理想的中心静脉导管插入深度。然而，它们很复杂，在需要快速处理的情况下往往不适用。
本研究旨在确定一种简单实用的方法，以预测小儿患者在实时超声引导下经右颈内静脉、左或右锁骨上入路后理想的中心静脉导管插入深度。
纳入2015年7月至2018年2月在德国圣奥古斯丁小儿心脏中心接受心血管手术的先天性心脏病小儿患者。从麻醉记录中获取身高、体重、患者年龄（月龄）和中心静脉导管插入深度。通过测量术后第一张胸部X线片上气管隆突水平与中心静脉导管尖端之间的距离，计算理想的中心静脉导管插入深度。研究身高、体重和患者年龄（月龄）与右颈内静脉、左锁骨上和右锁骨上入路理想中心静脉导管插入深度的关系。
身高是最佳参数，具有最佳的决定系数以及最简单的关系。根据对身高每增加10厘米时理想中心静脉导管插入深度的分析，每个身高都有一个理想的中心静脉导管插入深度，与麻醉医生所使用入路的经验无关。右颈内静脉入路和左锁骨上入路的理想中心静脉导管插入深度无显著差异，而右锁骨上入路的理想中心静脉导管插入深度明显短于其他两种入路。
本研究成功确定了一种视觉上简单实用的条形图，仅使用实时超声引导插入技术，即可预测经右颈内静脉入路、左锁骨上入路和右锁骨上入路插入中心静脉导管的理想深度。
