OPTIMAL PLACEMENT OF CVP CATHETER IN PEDIATRIC CARDIAC PATIENTS

For correct monitoring of central venous pressure (CVP) the tip of the CVP catheter should be placed in the superior vena cava (SVC). Since there is no useful guide for the optimal depth of insertion of CVP catheter in children undergoing cardiovascular surgery, we examined the relationship between the depth of the CVP catheter and easily measured body-size variables, such as age, weight and height, and then created a guide for the optimal placement of the paediatric population. The CVP catheterization was performed through the right internal jugular vein by the high approach. The position of the catheter lip was determined by the wave form of the CVP tracing and the depth of insertion was assessed by the external marking on the catheter at the cannulation site. The position of the catheter lip, determined by postoperative AP chest x-ray, was identified by the level of thoracic vertebra (T) corresponding to the position of the catheter tip. We analyzed the relationship between the depth of the catheter and patient's age, weight and height by linear regression analysis. The position of lip was normally distributed from T-1 to T-7 and the tips were centralized at levels of T-3, T-4 and T-5 which anatomically correspond to SVC. We r values between the catheter depth and the three factors at each level were comparable, although the correlation between the depth of catheter and height was best. A simple guide for placement of the catheter tip at T-3, T-4 and Tg levels as a function of patient's height was created. Since height is a primary information variable which ir available even in emergency cases, we believe that the guide is acceptable and valuable to anaesthetists.