Fluoroscopic landmark for SVC-RA junction for central venous catheter placement in children

Background. Vascular access devices are commonly placed under image guidance. The usual aim is to place the tip at the superior vena cava-right atrial juntion (SVC-RA), Objective. To identify a radiographic landmark for the SVC-RA junction that would be useful for accurate central venous catheter tip placement in children. Materials and methods. Images from 56 children undergoing contrast studies of their upper limb venous systems were examined for location of the SVC-RA in relation to a radiographic landmark. Results. Most patients (92.5%) showed the SVC-RA junction to lie at the sixth thoracic vertebral level or the interspace above or below. The SVC-RA junction lay lower than the right main bronchus and the notch on the right cardiome-diastinal contour. Conclusion. The vertebral body provides a useful and radiographically visible landmark for accurate central catheter tip placement.