Topographic analysis and evaluation of anatomical landmarks for placement of central venous catheters based on conventional chest X-ray and computed tomography

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Presentation transcript:

Topographic analysis and evaluation of anatomical landmarks for placement of central venous catheters based on conventional chest X-ray and computed tomography M. Dulce, I.G. Steffen, A. Preuss, D.M. Renz, B. Hamm, T. Elgeti British Journal of Anaesthesia Volume 112, Issue 2, Pages 265-271 (February 2014) DOI: 10.1093/bja/aet341 Copyright © 2014 The Author(s) Terms and Conditions

Fig 1 Overview of the anatomical landmarks on CXR (a) and CT (b). On CXR, the SCJ and carina can easily be identified. In this example, one additional CVC has been inserted over the left subclavian vein on the CXR. The tip of the right CVC is therefore taken for measurements. Four different axial CT slices illustrate the anatomical landmarks used on CT for measurements: SCJ (upper margin of the right clavicular notch), confluence of the SVC (cephalad origin of the innominate veins), carina (cartilaginous ridge of the tracheal bifurcation), and pericardial reflection (thin line between SVC and ascending aorta or aortic arch). The extrapericardial SVC measures from the cephalad origin to pericardial reflexion, the intrapericardial part of the SVC from the pericardial reflection to the atriocaval junction (not shown). British Journal of Anaesthesia 2014 112, 265-271DOI: (10.1093/bja/aet341) Copyright © 2014 The Author(s) Terms and Conditions

Fig 2 Bland–Altman plots demonstrating the agreement of measurements in X-ray (CXR) and CT for the following distances: SCJ to carina (a), carina to CVC tip (b), and SCJ to CVC tip (c). The solid green lines represent the mean difference and the dashed blue lines indicate 95% LoA. Linear regression is displayed by the pink dot-dashed lines. CXR overestimates the carina-to-CVC distance on average by 10 mm (b) and the SCJ-to-CVC distance by 11 mm (c). British Journal of Anaesthesia 2014 112, 265-271DOI: (10.1093/bja/aet341) Copyright © 2014 The Author(s) Terms and Conditions

Fig 3 Topographic relationships of the SCJ, SVC, and carina measured in CT (standard of reference) and CXR. Distances from the SCJ to SVC origin and intra- and extrapericardial SVC sections are presented as bars (a), whereas the positions of the carina (as a possible landmark for CVC placement) are represented by dots. The determination of the optimal position of the CVC in CT is demonstrated by line plots using three different strategies for orientation: a fixed insertion length from the SCJ (b), a fixed distance from the carina (c), and a percentage of the SCJ-to-carina distance (d). CVC placements above the confluence of the SVC are displayed as orange lines, whereas CVC tips in the extrapericardial (extra) SVC are indicated by green lines and placements in the intrapericardial (intra) SVC by pink lines. The optimal distance to exclude intrapericardial placement is marked by a vertical dashed line, and the highest percentage of extrapericardial positions in the SVC is depicted by a vertical dotted line. British Journal of Anaesthesia 2014 112, 265-271DOI: (10.1093/bja/aet341) Copyright © 2014 The Author(s) Terms and Conditions