Abstract

Background: Correct positioning of the central venous catheter tip near or at the junction of the superior vena cava and right atrium is necessary for better monitoring and avoid complications.The anatomical landmark method is a simpler, cost effective, and performed at bedside, thereby facilitating safe positioning of the CVC tip. Therefore this study was conducted to compare the accuracy of the two method of central venous catheter positioning based on anatomical landmarks and Trans Eosophageal Echography.

Methods: After obtaining approval of hospital ethical committee and informed written consent 200 adult patients of either sex scheduled to undergo cardiac surgery were randomly allocated to Group 1,(Anatomical landmark) and Group 2 (Trans-esophageal echo-cardiography group) . The right internal jugular vein was cannulated to a depth calculated from apex of the sternocleidomastoid triangle and the junction of superior and middle one third of the manubrium and under the guidance of trans-esophageal echo-cardiography till SVC-RA junction respectively. The catheter was identified on TEE by Saline flush test. Catheter tip was considered acceptable up to 10mm to SVC –RA junction in both the groups on TEE

Results: The power of study was 80% and level of significance as 0.05.The two groups were matched. The average length of catheter inserted in anatomical landmark group was 10.36± 1.34 cm and in TEE group was at 10.90± 0.96 cm (p-value < 0.05).65% of catheter had correct placement of tip by anatomical landmark as assessed by TEE (p value <0.001). Out of 65, 40 had tip placed above SVC-RA junction with the mean distance 6.785 ± 1.78 mm and 4 had tip placed below the SVC-RA junction with the mean distance 7.75 ±2.87 mm and 21 tip was positioned at the SVC-RA junction on TEE.TEE guided catheter insertion resulted in 100% correct placement.

Conclusion: In our study we found that the anatomical landmark method is 65% accurate compared to TEE guided central venous catheter insertion. At the bedside, in an emergency situation where vascular access takes priority, anatomical landmark method can be safely practiced to insert central venous catheter to an appropriate depth

Keywords: Internal jugular venous catheters, anatomical landmarks