Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Paediatr Anaesth. 2021 Mar;31(3):346-351. doi: 10.1111/pan.14107. Epub 2021 Jan 27.
Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children.
We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children.
This prospective observational study included 36 children (age <6 years; weight ≥5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound-guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real-time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples.
Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = .806, 95% confidence interval [CI]: 0.658-0.908; p < .001). Bland-Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14-0.58, 95% limits of agreement: -0.92, 1.64). All plots were above the -1.0 line, indicating no catheter tip insertion into the right atrium.
Optimal insertion depth for an ultrasound-guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.
在儿童中，用于中心静脉通路的超声引导锁骨下入路确定最佳锁骨下静脉（SCV）导管插入深度的方法存在争议。
我们研究了超声引导锁骨下入路确定 SCV 导管插入深度的改良公式在儿童中的适用性和可靠性。
本前瞻性观察研究纳入了 36 名（年龄<6 岁；体重≥5kg）拟行先天性心脏病手术的儿童。插管后，行超声引导锁骨下入路 SCV 导管插入术。实际插入深度通过实时经食管超声心动图确定。插入深度通过从插入点到右锁骨胸骨端的距离与从该点到从右锁骨胸骨端到连接乳头的线的垂直线中点的距离之和减去 1cm 来计算。
改良公式计算的插入深度与 SCV 导管的实际插入深度高度相关（r=0.806，95%置信区间[CI]：0.658-0.908；p<0.001）。Bland-Altman 分析显示平均偏差和精度分别为 0.36 和 0.65cm（95%CI：0.14-0.58，95%限界：-0.92，1.64）。所有图均高于-1.0 线，表明导管尖端未插入右心房。
对于年龄小于 6 岁且体重大于 5kg 的儿童，可以通过修改体表标志公式来计算超声引导锁骨下入路 SCV 导管插入的最佳深度。
