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

Autor: Kandasamy M; Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia., Xue S; Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia., McGregor N; Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia., Xiang H; Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.; University of New South Wales, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: Journal of medical imaging and radiation oncology [J Med Imaging Radiat Oncol] 2024 Sep; Vol. 68 (6), pp. 667-672. Date of Electronic Publication: 2024 Aug 29.
DOI: 10.1111/1754-9485.13741
Abstrakt: Introduction: Central 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.
Methods: Chest 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.
Results: The 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.
Conclusion: We propose that the CVC tip can be placed at the mid-superior right heart border landmark.
(© 2024 Royal Australian and New Zealand College of Radiologists.)
Databáze: MEDLINE
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