Abstract
Purpose
The key landmark for tip position of a central venous catheter (CVC) is the SVC-RA junction. In adults, localization of the SVC-RA junction may be assessed as a function of vertebral body units (VBU) below the carina during CVC placement. We investigated the relationship between the SVC-RA junction and the carina in children.
Materials and methods
584 CT scans of 0–18 years were analyzed. The carina was marked automatically by software while the SVC-RA junction and vertebrae were marked manually. The SVC-RA junction to carina (JC) distance was the primary study measurement reported in both VBU and mm.
Results
The data show an average JC distance of 1.25 VBU for 0–1 year, 1.27 VBU for 1–4 years, 1.34 VBU for 4–9 years, 1.53 VBU for 9–15 years, and 1.64 VBU for 15–18 years. A positive relationship between weight and JC distance was also demonstrated.
Conclusion
JC distance is a useful predictor of SVC-RA junction location in children. Significant relationships were shown between JC distance and both age and weight. Due to small differences between age groups, however, average JC distance for all comers (1.48 VBU, 95% CI 0.7 – 2.3) can be used for SVC-RA junction identification in CVC placement.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Somme S, Bronsert M, Morrato E, Ziegler M (2013) Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 132(6):e1466–e1472
Hsu J-H, Wang C-K, Chu K-S et al (2006) Comparison of radiographic landmarks and the echocardiographic svc/ra junction in the positioning of long-term central venous catheters. Acta Anaesthesiol Scand 50:731–735
Gish J, Wright T, Gadepalli S, Jarboe M (2016) Avoiding postoperative malposition of upper body tunneled central venous catheters in children: evaluating technique and depth of placement. J Pediatr Surg 51(8):1336–1340
Nayeemuddin M, Pherwani A, Asquith J (2013) Imaging and management of complications of central venous catheters. Clin Radiol 68(5):529–544
Collier PE, Blocker SH, Graff DM, Doyle P (1998) Cardiac tamponade from central venous catheters. Am J Surg 176:212–214
Dane T, King E (1975) Fatal cardiac tamponade and other mechanical complications of central venous catheters. Br J Surg 62:6–10
Chan TY, England A, Meredith SM, McWilliams RG (2016) Radiologist variability in assessing the position of the cavoatrial junction on chest radiographs. Br J Radiol 89(1065):20150965
Baskin KM, Jimenez RM, Cahill AM et al (2008) Cavoatrial junction and central venous anatomy: implications for central venous access tip position. J Vasc Interv Radiol 19:359–365
Song Y, Byun J, Hwang S et al (2015) Use of vertebral body units to locate the cavoatrial junction for optimum central venous catheter tip positioning. Br J Anaesth 115:252–257
Englesbe MJ, Terjimanian MN, Lee JS et al (2013) Morphometric age and surgical risk. J Am Coll Surg 216:976–985
Harbaugh CM, Terjimanian MN, Lee JS et al (2013) Abdominal aortic calcification and surgical outcomes in patients with no known cardiovascular risk factors. Ann Surg 257:774–781
Lee JS, He K, Harbaugh CM et al (2011) Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. J Vasc Surg 53:912–917
Lee JS, Terjimanian MN, Tishberg LM et al (2011) Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy. J Am Coll Surg 213:236–244
Harbaugh CM, Zhang P, Henderson B et al (2017) Personalized medicine: enhancing our understanding of pediatric growth with analytic morphomics. J Pediatr Surg 52(5):837–842
Parenteau CS, Ehrlich P, Ma L et al (2013) The quantification of liver anatomical changes and assessment of occupant liver injury patterns. Stapp Car Crash J 57:267–283
Zhang P, Parenteau C, Wang L et al (2013) Prediction of thoracic injury severity in frontal impacts by selected anatomical morphomic variables through model-averaged logistic regression approach. Accid Anal Prev 60:172–180
Core Team R (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JRH, MDJ, and BAD. The first draft of the manuscript was written by JRH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
Stewart Wang is the founder and sole proprietor of Applied Morphomics Incorporated and is role founder and equity owner of PRENOVO. He has a patent awarded for analytic morphomics (United States PCT/US2013/057501. 2012 August 30). The rest of the authors declare that they have no conflict of interest.
Ethics approval
The authors certify that they comply with the ethical guidelines for authorship and publishing of Pediatric Surgery International. This study was approved by the University of Michigan Institutional Review Board (HUM00041441), allowing access to any CT scan performed retrospectively on patients for trauma and non-trauma indications within the University of Michigan Health System. Informed consent was waived by the IRB.
Informed consent
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hirschl, J.R., Gadepalli, S.K., Derstine, B.A. et al. CT validation of SVC-RA junction location for pediatric central line placement: is vertebral bodies below the carina accurate?. Pediatr Surg Int 36, 1055–1060 (2020). https://doi.org/10.1007/s00383-020-04712-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-020-04712-1