Liu Ce, Zhao Xiaojing, Wang Huanhuan, Huang Yan, Ma Sijia, Shi Zhangyuan, Duan Shuzhong
Nephrology Department, The Affiliated Hospital of Chengde Medical University, Chengde, China.
Metabolic Vascular Disease Group, Hebei Key Laboratory of Panvascular Diseases, Chengde, China.
Ren Fail. 2025 Dec;47(1):2496435. doi: 10.1080/0886022X.2025.2496435. Epub 2025 May 6.
Catheterization methods use the lower margin of the right third intercostal space to predict the catheter tip position; however, adjustments are often necessary. We evaluated the catheter position and surface markers of the chest and the relevant factors that affect the position and depth of the catheter tip. This single-center, cross-sectional study included 173 patients who underwent right internal jugular vein tunnel insertion with a tunneled cuffed catheter (TCC). The sternal length, intercostal width, anterior-to-posterior sternal diameter, and transverse diameter of the thorax were recorded, and the thoracic aspect ratio was calculated. The cardiothoracic ratio and position of the catheter tip were measured using chest computed tomography. The correct placement was when the catheter tip was in the upper 1/3 of the right atrium (deep group: below the correct placement; shallow group: above the correct placement). Catheter tip indices were subjected to logistic regression analyses. A receiver operating characteristic (ROC) curve was used to assess the risk and optimal cutoff of the catheter tip depth. There were significant differences in sternum length, cardiothoracic ratio, anterior-to-posterior thoracic diameter, and thoracic aspect ratio between the groups ( < 0.05). The latter three variables were influencing factors for catheter tip depth ( < 0.05). The anterior-to-posterior thoracic diameter ( = 0.003; cutoff, 22.5 cm; ROC, 0.695) and thoracic aspect ratio ( = 0.014; cutoff, 0.74; ROC, 0.632) were independent risk factors for catheter tip depth and position, respectively. The position of the TCC catheter tip was related to the sternal length, anterior-to-posterior thoracic diameter, thoracic aspect ratio, and cardiothoracic ratio.
导管插入方法采用右第三肋间间隙的下缘来预测导管尖端位置；然而，通常需要进行调整。我们评估了导管位置、胸部表面标记以及影响导管尖端位置和深度的相关因素。这项单中心横断面研究纳入了173例行右颈内静脉隧道式带 cuff 导管（TCC）置入术的患者。记录胸骨长度、肋间隙宽度、胸骨前后径和胸廓横径，并计算胸廓纵横比。使用胸部计算机断层扫描测量心胸比率和导管尖端位置。正确放置是指导管尖端位于右心房上1/3处（深组：低于正确放置位置；浅组：高于正确放置位置）。对导管尖端指标进行逻辑回归分析。采用受试者工作特征（ROC）曲线评估导管尖端深度的风险和最佳截断值。两组之间在胸骨长度、心胸比率、胸廓前后径和胸廓纵横比方面存在显著差异（<0.05）。后三个变量是导管尖端深度的影响因素（<0.05）。胸廓前后径（=0.003；截断值，22.5 cm；ROC，0.695）和胸廓纵横比（=0.014；截断值，0.74；ROC，0.632）分别是导管尖端深度和位置的独立危险因素。TCC导管尖端的位置与胸骨长度、胸廓前后径、胸廓纵横比和心胸比率有关。
