Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Department of Prevention and Management, Inha University Hospital, Incheon, Korea.
World J Surg. 2020 Jul;44(7):2170-2174. doi: 10.1007/s00268-020-05449-7.
Central venous catheters should be positioned at the cavoatrial junction or the right atrium. If catheters are inserted to a depth derived by adding the length between the needle insertion point and the clavicular notch and the length between the clavicular notch and the carina, the catheter tip can be placed near the carina. Based on this, we aim to make a formula to place a catheter tip near the cavoatrial junction.
This prospective nonrandomized interventional study included patients who needed a central venous catheter from June 2017 to July 2018. The location of the cavoatrial junction was identified using a fluoroscopic technique. The following variables were measured: L1, the length between the needle insertion point and the clavicular notch; L2, the length between the clavicular notch and the carina; and α, the length between the carina and the cavoatrial junction.
A total of 70 patients were enrolled. The mean age was 65.5 ± 11.6 years, and 62.9% were male. The mean L1 and L2 were 7.6 ± 1.4 and 7.0 ± 1.4 cm, respectively. The mean α was 4.4 ± 1.5 cm (95% CI 4.1-4.8), and it was not affected by demographic factors, such as sex, age, height or weight.
Central venous catheters in adult patients can be placed near the cavoatrial junction using a simple formula: the distance between the insertion point and the clavicular notch + the distance between the clavicular notch to the carina + 4.4 cm.
中心静脉导管应置于腔静脉与心房交界处或右心房。如果将导管插入到从针尖插入点与锁骨切迹之间的长度加上锁骨切迹与隆嵴之间的长度的深度，则导管尖端可置于隆嵴附近。基于此，我们旨在制定一个将导管尖端置于腔静脉与心房交界处附近的公式。
本前瞻性非随机介入研究纳入了 2017 年 6 月至 2018 年 7 月需要中心静脉导管的患者。使用透视技术确定腔静脉与心房交界处的位置。测量以下变量：L1，针尖插入点与锁骨切迹之间的长度；L2，锁骨切迹与隆嵴之间的长度；α，隆嵴与腔静脉与心房交界处之间的长度。
共纳入 70 例患者，平均年龄为 65.5±11.6 岁，62.9%为男性。平均 L1 和 L2 分别为 7.6±1.4cm 和 7.0±1.4cm。平均α为 4.4±1.5cm（95%CI 4.1-4.8），不受性别、年龄、身高或体重等人口统计学因素的影响。
使用简单的公式可以将成人患者的中心静脉导管置于腔静脉与心房交界处附近：针尖插入点与锁骨切迹之间的距离+锁骨切迹至隆嵴之间的距离+4.4cm。
