Optimising central venous catheter placement by comparing cavoatrial junction position to chest X‐ray landmarks: A cross‐sectional study using CT chest reconstruction

Author:

Kandasamy Mayooran1ORCID,Xue Stanley1ORCID,McGregor Nigel1,Xiang Hao12ORCID

Affiliation:

1. Department of Radiology Concord Repatriation General Hospital Sydney New South Wales Australia

2. University of New South Wales Sydney New South Wales Australia

Abstract

AbstractIntroductionCentral venous catheter (CVC) tip placement guided by chest X‐ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X‐ray landmarks.MethodsChest CTs of 100 patients were retrospectively assessed. CT images were converted to a ‘virtual CXR’ using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes.ResultsThe mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup‐RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat‐RHB) was 18.4 mm below the CAJ. A new landmark: the mid‐superior right heart border, defined as the mid‐point between the Sup‐RHB and Lat‐RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ.ConclusionWe propose that the CVC tip can be placed at the mid‐superior right heart border landmark.

Publisher

Wiley

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