Positioning internal jugular venous catheters using the right third intercostal space in children

Background: Central venous catheters are used for pressure measurement, and drug and fluid therapy in children. Several reports have described serious complications related to catheter positioning. We evaluated the possibility of using the right third intercostal space as an anatomic landmark for determining the optimal insertion depth of a central venous catheter from the right internal jugular vein. Methods: The distance between the skin puncture site and the right third intercostal space (SK-ICS) was measured in 83 children. The catheter was inserted to a depth equal to the measured distance. Postoperatively, the distance between the catheter tip and the radiographic junction of the superior vena cava and the right atrium was measured. This was defined as the optimal catheter length, which placed the catheter tip at the SVC/RA junction (SK-SVC/RA). Results: A significant correlation was found between the SK-ICS and SK-SVC/RA (regression equation: SK-SVC/RA=0.35+0.98 x SK-ICS, r(2)=0.8554). Based on the data obtained, a simple formula, SK-ICS-1 (cm), predicted that a CVC would be positioned above the RA in 98.8% of patients. Conclusions: Using the right third intercostal space as an anatomic landmark allows positioning of the catheter tip in the SVC near to but not in the RA in children.