Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres’ formula or a radiological landmark-based approach: a.

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Transoesophageal echocardiographic evaluation of central venous catheter positioning using Peres’ formula or a radiological landmark-based approach: a prospective randomized single-centre study† J.H. Ahn, I.S. Kim, J.H. Yang, I.G. Lee, D.H. Seo, S.P. Kim British Journal of Anaesthesia Volume 118, Issue 2, Pages 215-222 (February 2017) DOI: 10.1093/bja/aew430 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 J-tip of guidewire and RA–SVC junction on a transoesophageal echocardiographic bicaval view. The RA–SVC junction (arrow) was defined as the base of the superior edge of the crista terminalis. IVC, inferior vena cava; LA, left atrium; RA, right atrium; SVC, superior vena cava. British Journal of Anaesthesia 2017 118, 215-222DOI: (10.1093/bja/aew430) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 Consort flow diagram. British Journal of Anaesthesia 2017 118, 215-222DOI: (10.1093/bja/aew430) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 Correlation between the actual distance from the skin insertion point to the RA–SVC junction and the catheter insertion depth in the P group (a) and in the R group (b). Values for IJV access are shown as open circles and for subclavian venous access as filled triangles. The continuous lines are the correlation lines, combining the two routes of access. IJV, internal jugular vein; IVC, inferior vena cava; RA, right atrium; SVC, superior vena cava. British Journal of Anaesthesia 2017 118, 215-222DOI: (10.1093/bja/aew430) Copyright © 2017 The Author(s) Terms and Conditions

Fig 4 Position of the catheter tip in relationship to the RA–SVC junction. Zero position refers to the level of the RA–SVC junction. Positive and negative values refer to the tip position above and below the RA–SVC junction, respectively. Error bars indicate the mean and sd. An optimal position is defined as the tip being located within 2 cm above and 1 cm below the RA–SVC junction, and is indicated with dashed lines. RA, right atrium; SVC, superior vena cava. British Journal of Anaesthesia 2017 118, 215-222DOI: (10.1093/bja/aew430) Copyright © 2017 The Author(s) Terms and Conditions

Fig 5 Abutment of catheter tip and flow stream in a subject with a low BMI who underwent internal jugular vein catheterization. The catheter tip (arrow) abutted the medial wall of the SVC, but the flow stream was linear. IVC, inferior vena cava; LA, left atrium; SVC, superior vena cava. British Journal of Anaesthesia 2017 118, 215-222DOI: (10.1093/bja/aew430) Copyright © 2017 The Author(s) Terms and Conditions