Hirschl Jacob R, Gadepalli Samir K, Derstine Brian A, Holcombe Sven A, Smith Ethan A, Wang Stewart C, Ehrlich Peter F, Jarboe Marcus D
Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Drive., SPC 4211, Ann Arbor, MI, 48109-4211, USA.
Morphomics Analysis Group, University of Michigan, Ann Arbor, MI, USA.
Pediatr Surg Int. 2020 Sep;36(9):1055-1060. doi: 10.1007/s00383-020-04712-1. Epub 2020 Jul 14.
The key landmark for tip position of a central venous catheter (CVC) is the SVC-RA junction. In adults, localization of the SVC-RA junction may be assessed as a function of vertebral body units (VBU) below the carina during CVC placement. We investigated the relationship between the SVC-RA junction and the carina in children.
584 CT scans of 0-18 years were analyzed. The carina was marked automatically by software while the SVC-RA junction and vertebrae were marked manually. The SVC-RA junction to carina (JC) distance was the primary study measurement reported in both VBU and mm.
The data show an average JC distance of 1.25 VBU for 0-1 year, 1.27 VBU for 1-4 years, 1.34 VBU for 4-9 years, 1.53 VBU for 9-15 years, and 1.64 VBU for 15-18 years. A positive relationship between weight and JC distance was also demonstrated.
JC distance is a useful predictor of SVC-RA junction location in children. Significant relationships were shown between JC distance and both age and weight. Due to small differences between age groups, however, average JC distance for all comers (1.48 VBU, 95% CI 0.7 - 2.3) can be used for SVC-RA junction identification in CVC placement.
中心静脉导管（CVC）尖端位置的关键标志是上腔静脉-右心房（SVC-RA）交界处。在成人中，放置CVC期间，可根据隆突下方的椎体单位（VBU）来评估SVC-RA交界处的位置。我们研究了儿童中SVC-RA交界处与隆突之间的关系。
分析了584例0至18岁患者的CT扫描图像。软件自动标记隆突，同时人工标记SVC-RA交界处和椎体。SVC-RA交界处至隆突（JC）的距离是主要研究测量指标，分别以VBU和毫米报告。
数据显示，0至1岁患者的平均JC距离为1.25 VBU，1至4岁为1.27 VBU，4至9岁为1.34 VBU，9至15岁为1.53 VBU，15至18岁为1.64 VBU。还证实了体重与JC距离之间呈正相关。
JC距离是儿童SVC-RA交界处位置有用的预测指标。JC距离与年龄和体重之间均显示出显著相关性。然而，由于各年龄组之间差异较小，所有患者的平均JC距离（1.48 VBU，95%可信区间0.7 - 2.3）可用于CVC放置时SVC-RA交界处的识别。
