Optimal Length of a Right Subclavian Venous Catheter in Koreans and the Usefulness of Echocardiography for Evaluation of the Central Venous Catheter Position

Oh, Sung Bum; Kim, Hyun; Kim, Ho Jung; Kim, Gyeong Jin; Lee, Kang Hyun; Hwang, Sung Oh; An, Hee Chul

Abstract

PURPOSE
We evaluated the proper length of a central venous catheter (CVC) during subclavian vein catheterization and the usefulness of transthoracic echocardiography in identifying the position of the CVC.
METHODS
From August 2002 to September 2002, we studied prospectively 30 consecutive patients who had a CVC inserted. The right subclavian vein was punctured by using the Seldinger method, and the patients were divided into two groups according to the method used to identify the position of the central venous catheter. In the radiology group, after central venous catheterization, we identified the position of the CVC by using a plain chest X-ray; then, we adjusted the length of the catheter. In the echocardiography group, during central venous catheterization, we inserted it deeply enough to observe the tip of the catheter in the right atrium by using echocardiography; then, we withdrew the catheter slowly until it was no longer observed in the right atrium, and we fixed the catheter at that position. We measured the heights, weights, and chest circumferences of the patients. RESULT: The maximal lengths of CVCs were 15.9+/-2.0 cm in the radiology group and 15.9+/-1.7 cm in the echocardiography group. There was no difference between the two groups (p=0.98). The maximal length of the CVC correlated to the height of the patient (Y=0.154X-9.8: Y=the length of the CVC, X=height, p<0.001, R2=0.394) and to the weight of the patient (Y=0.076X+11.2: Y = the length of the CVC, X=weight, p=0.042, R2=0.140), but not to the chest circumference (p=0.371).
CONCLUSION
Echocardiography was a useful method in identifying the optimal positioning in central venous catheterization. The maximal length of the CVCs was 15.9 +/-1.9 cm via the subclavian vein approach in Koreans and correlated to the height of the patients.