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Korean Journal of Anesthesiology 1999;37(4):563-568.
DOI: https://doi.org/10.4097/kjae.1999.37.4.563   
Determination of the Depth of Subclavian Catheter Insertion Using Chest Anteror-Posterior Film.
Ki Cheol Kang, Choon Kun Chung, Dae Hyun Jo, Hae Kyoung Kim
Department of Anesthesiology, College of Medicine, Inha University Inha General Hospital, Seongnam, Korea.
Cardiac tamponade is a rare but fatal complication of subclavian catheter insertion and maintenance. This happens due to erosion of the cardiac wall or the superior vena cava distal to the CLPR (cephalic limit of pericardial reflection). This study is designed to present a method of locating the catheter tip proximal to the CLPR, and to evaluate its results.
Forty adult patients with intracranial hemorrhages who needed craniotomies and central venous catheter insertions were recruited. The right subclavian vein was selected as the insertion route. On Chest AP film, clavicle, supraclavicular notch and trachobronchial tree were used as landmarks. The CLPR was assumed to be at the level of the angle between the right main bronchus and the trachea. Needle depth was measured from the skin puncture site to the point where blood was regurgitated by the Chest AP landmarks. Intravascular depth was measured from the point where blood was regurgitated to the CLPR. The sum of these two points was regarded as being the appropriate depth of the subclavian catheter insertion. In the control group (n = 40), the right subclavian catheter was inserted to the depth of height (cm)/10 minus 2 cm.
In study group, the catheter tips were located proximal to the CLPR in about 2/3 (27/40) of the patients, and there was no case in which catheter tip was distal to the superior vena cava-right atrium junction. In the control group, catheter tips were proximal to the CLPR in only 10% of the patients and distal to the SVC/RA junction in 42.5%.
This method decreased the incidence of locating the tip of the catheter distal to the CLPR, and prevented any intracardial location of the catheter tip.
Key Words: Complications, cardiovascular; Monitoring, central venous pressure; Veins, cannulation, subclavian


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