Depth of Central Venous Catheterization by Intracardiac Electrocardiogram in Adults

Abstract

Background: Central venous catheterization is done frequently in cardiac surgery and intensive care settings. Faulty positioning of the catheter can cause many complications. Objectives: The aim of our study was to study the average depth of insertion and formulate a general guideline through the right internal jugular vein (IJV). Patients and Methods: The right IJV was cannulated over a period of four months and catheter tip positioning was guided by means of an intracardiac electrocardiogram (ECG). Insertion depth was registered at the position of maximum P wave amplitude and the catheter was fixed after withdrawing 2 cm. Pearsons correlation coefficient was calculated to categorize any relationship between plots of distance versus patients height, and regression lines and equations were also calculated. Bland-Altman analysis of data was done to compare the old formulae with our derived formulae. Results: A total of 155 adult patients were studied. Distances measured were found to be highly correlated with a patients height, followed by body surface area (BSA) and weight. For right IJV cannulation in valvular surgeries in adults, the depth of insertion (cm) was (height in cm / 15) + 2 1.58 (SD) and in non-valvular surgeries in adults, it was (height in cm/15) + 1.4 1.47 (SD). The bias was very small when the new formulae were compared to the existing formulae. Conclusions: The devised formulae predicted the required depth of catheters thereby reducing the possibility of complications and need for radiographic confirmation.