Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 24 , ISSUE 7 ( July, 2020 ) > List of Articles

Original Article

Comparison of Peres’ Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters

AR Manudeep, BP Manjula, US Dinesh Kumar

Citation Information : Manudeep A, Manjula B, Kumar UD. Comparison of Peres’ Formula and Radiological Landmark Formula for Optimal Depth of Insertion of Right Internal Jugular Venous Catheters. Indian J Crit Care Med 2020; 24 (7):527-530.

DOI: 10.5005/jp-journals-10071-23478

License: CC BY-NC 4.0

Published Online: 18-11-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Background: Central venous catheterization is a vital procedure for volume resuscitation, infusion of drugs, and for central venous pressure monitoring in the perioperative period and intensive care unit (ICU). It is associated with position-related complications like arrhythmias, thrombosis, tamponade, etc. Several methods are used to calculate the catheter insertion depth so as to prevent these position-related complications. Objective: To compare Peres’ formula and radiological landmark formula for central venous catheter insertion depth through right internal jugular vein (IJV) by the anterior approach. Materials and methods: A total of 102 patients posted for elective cardiac surgery were selected and divided into two equal groups—Peres’ group (group P) and radiological landmark group (group R). Central venous catheterization of right IJV was done under ultrasound (USG) guidance. In group P, central venous catheter insertion depth was calculated as height (cm)/10. In group R, central venous catheter insertion depth was calculated by adding the distances from the puncture point to the right sternoclavicular joint and on chest X-ray the distance from the right sternoclavicular joint to carina. After insertion, the catheter tip position was confirmed using transesophageal echocardiography (TEE) in both the groups. Results: About 49% of the catheters in group P and 74.5% in group R were positioned optimally as confirmed by TEE, which was statistically significant. No complications were observed in both the groups. Conclusion: Radiological landmark formula is superior to Peres’ formula for measuring optimal depth of insertion of right internal jugular venous catheter.

  1. Chhabra L, Spodick DH. Complete heart block—an underappreciated serious complication of central venous catheter placement. J Electrocardiol 2012;45(6):790–792. DOI: 10.1016/j.jelectrocard.2012.06.005.
  2. Robinson JF, Robinson WA, Cohn A, Garg K, Armstrong 2nd JD. Perforation of the great vessels during central venous line placement. Arch Intern Med 1995;155(11):1225–1228. DOI: 10.1001/archinte.1995.00430110149016.
  3. Collier PE, Blocker SH, Graff DM, Doyle P. Cardiac tamponade from central venous catheters. Am J Surg 1998;176(2):212–214. DOI: 10.1016/S0002-9610(98)00171-8.
  4. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003;14(5):527–534. DOI: 10.1097/01.RVI.0000071097.76348.72.
  5. Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth 2000;85(2):188–191. DOI: 10.1093/bja/85.2.188.
  6. Peres PW. Positioning central venous catheters—a prospective survey. Anaesth Intensive Care 1990;18(4):536–539. DOI: 10.1177/0310057X9001800422.
  7. Joshi AM, Bhosale GP, Parikh GP, Shah VR. Optimal positioning of right-sided internal jugular venous catheters: comparison of intra-atrial electrocardiography vs Peres’ formula. Indian J Crit Care Med 2008;12(1):10–14. DOI: 10.4103/0972-5229.40943.
  8. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. Br J Anesth 2000;85(2):192–194. DOI: 10.1093/bja/85.2.192.
  9. Stonelake PA, Bodenham AR. The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth 2006;96(3):335–340. DOI: 10.1093/bja/aei310.
  10. Ahn J, Kim I, Yang J, Lee I, Seo D, Kim S. Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres’ formula or a radiological landmark-based approach: a prospective randomized single-centre study. Br J Anaesth 2017;118(2):215–222. DOI: 10.1093/bja/aew430.
  11. Lee J, Bahk J, Ryu H, Jung C, Jeon Y. Comparison of the bedside central venous catheter placement techniques: landmark vs electrocardiogram guidance. Br J Anaesth 2009;102(5):662–666. DOI: 10.1093/bja/aep046.
  12. Wirsing M, Schummer C, Neumann R, Steenbeck J, Schmidt P, Schummer W. Is traditional reading of the bedside chest radiograph appropriate to detect Intra-atrial central venous catheter position? Chest 2008;134(3):527–533. DOI: 10.1378/chest.07-2687.
  13. Andropoulos DB, Stayer SA, Bent ST, Campos CJ, Bezold LI, Alvarez M, et al. A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients. Anesth Analg 1999;89(1):65–70. DOI: 10.1213/00000539-199907000-00012.
  14. Chaney M, Minhaj M, Patel K, Muzic D. Transoesophageal echocardiography and central line insertion. Ann Card Anaesth 2007;10(2):127. DOI: 10.4103/0971-9784.37938.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.