Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Paediatr Anaesth. 2020 Apr;30(4):490-497. doi: 10.1111/pan.13836. Epub 2020 Feb 13.
The external anatomical landmark and the radiological landmark have been introduced to provide estimation of the depth of right internal jugular venous catheter during insertion.
This study aimed to compare the accuracy, agreement, and reliability of the external anatomical landmark and the radiological landmark, confirmation being by transesophageal echocardiography.
This prospective observational study was conducted in children ages 1-15 years. The catheter was placed at the superior vena cava and the right atrium junction guided by transesophageal echocardiography. The catheter depth derived from the transesophageal echocardiography, the external anatomical landmark, and the radiological landmark was recorded. The optimal zone of the catheter tip was 5 mm below and 10 mm above the superior vena cava and the right atrium junction. Accuracy was assessed by the difference between the transesophageal echocardiography and the external anatomical landmark or the radiological landmark. Agreement with Bland-Altman plots and correlation were tested.
Eighty participants, median age of 3 years, were enrolled. The median (IQR) differences between the depth of the transesophageal echocardiography and the external anatomical landmark or the radiological landmark were 0.30 (0, 0.70) and 0.10 (-0.20, 0.90) cm, respectively. Bland-Altman plots demonstrated good agreement between the depths. The catheter tips were located in the optimal zone more frequently with the external anatomical landmark than the radiological landmark (94.7% vs 64.5%). The external anatomical landmark showed a stronger correlation to transesophageal echocardiography than the radiological landmark (r = .95 vs .83).
Both the external anatomical landmark and the radiological landmark enabled accurate estimation of the central venous catheter depth close to the superior vena cava and the right atrium junction. The external anatomical landmark is of more potential use than the radiological landmark in clinical practice.
外部解剖学标志和影像学标志已被引入，以提供在插入过程中对右侧颈内静脉导管深度的估计。
本研究旨在比较外部解剖学标志和影像学标志的准确性、一致性和可靠性，通过经食管超声心动图确认。
本前瞻性观察性研究纳入了 1-15 岁的儿童。在经食管超声心动图引导下，将导管放置在上腔静脉和右心房交界处。记录导管深度，从经食管超声心动图、外部解剖学标志和影像学标志得出。导管尖端的最佳区域为上腔静脉和右心房交界处下方 5 毫米和上方 10 毫米。通过经食管超声心动图与外部解剖学标志或影像学标志之间的差异来评估准确性。通过 Bland-Altman 图和相关性测试来评估一致性。
共纳入 80 名参与者，中位年龄为 3 岁。经食管超声心动图与外部解剖学标志或影像学标志之间的深度差异中位数（IQR）分别为 0.30（0，0.70）和 0.10（-0.20，0.90）cm。Bland-Altman 图显示深度之间具有良好的一致性。外部解剖学标志引导下导管尖端更频繁地位于最佳区域（94.7%比 64.5%）。外部解剖学标志与经食管超声心动图的相关性强于影像学标志（r=.95 比.83）。
外部解剖学标志和影像学标志都能准确估计靠近上腔静脉和右心房交界处的中心静脉导管深度。在临床实践中，外部解剖学标志比影像学标志更具潜力。
