Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 13 , ISSUE 3 ( September, 2009 ) > List of Articles


How correct is the correct length for central venous catheter insertion

S. Manimala Rao, M. Mrinal

Keywords : Carina, central venous catheters, right and left internal jugular vein

Citation Information : Rao SM, Mrinal M. How correct is the correct length for central venous catheter insertion. Indian J Crit Care Med 2009; 13 (3):159-162.

DOI: 10.4103/0972-5229.58543

License: CC BY-ND 3.0

Published Online: 01-09-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Background and Aim: Central venous catheters (CVC) are important in the management of critically ill patients. Incorrect positioning may lead to many serious complications. Chest radiograph is a convenient means of determining the correct position of the catheter tip. The present study was designed to evaluate the depth of CVC placed through the right and left internal jugular vein (IJV) in order to achieve optimum placement of the catheter tip. Materials and Methods: A total of 107 patients in whom CVCs were put through either the right or left IJV through a central approach were included in this prospective study. Catheter tip position was observed in the post procedure chest radiograph. It was considered correct if the tip was just below the carina in the left-sided catheters and just above carina in the right-sided catheters. The catheters were repositioned based on the chest radiographs. The catheter depth leading to optimum tip placement was noted. Results: In males, catheter repositioning was required in 13 of 58 patients (22.41%) in the right IJV catheters, whereas in 2 of 13 patients (15.38%) in the left IJV catheters. In females, repositioning was required in 12 of 25 patients (48%) in the right IJV catheters and 2 of 11 patients (18.18%) in the left IJV catheters. Repositioning rate was higher in females (14/36) compared with males (15/71), which was statistically significant (P = 0.05, 95% CI). Repositioning rates were significantly higher in females (12/25) as compared with males (13/58) in the right IJV catheters (P = 0.019, 95% CI). Conclusion: By cannulating the IJV through a central approach, the catheters can be fixed at a length of 12-13 cm in males and 11-12 cm in females in the right IJV and at a length of 13-14 cm in males and 12-13 cm in females in the left IJV in order to achieve correct positioning.

PDF Share
  1. Ventricular tachycardia resulting from central venous catheter tip migration due to arm position changes: Report of two cases. Anesthesiology 1985;62:185-7.
  2. Preventing Complications of Central Venous catheterization. NEJM 2003;348:1123-33.
  3. Central venous catheters: Do we need to review practice on positioning? J Intensive Care Society 2008;9:228-31.
  4. The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth 2006;96:335-40.
  5. Bedside prediction of the central venous catheter insertion depth. Br J Anaesth 2007;98:225-7.
  6. Correct Depth of Insertion of Right Internal Jugular Central Venous Catheters Based on External Landmarks: Avoiding the Right Atrium. J Cardiothorac Vasc Anesth 2007;21:497-501.
  7. Evaluation of Formulas for Optimal Positioning of Central Venous Catheters. Chest 1995; 107:1662-4.
  8. Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula. Indian J Crit Care Med 2008;12:10-4.
  9. The accuracy of electrocardiogram controlled central line placement. Anesth Analg 2007;104:65-70.
  10. Use of electrocardiogram to position right atrial catheters during surgery. Ann Surg 1997;225:165-71.
  11. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anaesth 2006;53:978-83.
  12. Safe placement of central venous catheters: Where should the tip of the catheter lie. Br J Anaesth 2000;85:188-91.
  13. Accurate placement of central venous catheters: A prospective, randomized multicenter trial. Crit Care Med 1993;21:1118-23.
  14. Applied anatomy of the superior vena cava-the carina as a landmark to guide central venous catheter placement. Br J Anaesth 2004;92:75-7.
  15. Towards Optimal Central Venous Catheter Tip Position. In: Vincent JL, editor. Yearbook of Intensive Care and Emergency Medicine. Berlin Heidelberg: Springer; 2008. p. 581-90.
  16. Positioning central venous catheters-a prospective survey. Anaesth Intensive Care 1990;18:536-9.
  17. Accurate placement of central venous catheters using a 16-cm Catheter. J Intensive Care Med 1996;11:19-22.
  18. Thirteen centimetre central venous catheters, lucky for all? Anaesthesia 2003;58:388..
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.