Depth of Central Venous Catheterization by Intracardiac Electrocardiogram in Adults

BACKGROUND Central venous catheterization is done frequently in cardiac surgery and intensive care settings. Faulty positioning of the catheter can cause many complications. OBJECTIVES The aim of our study was to study the average depth of insertion and formulate a general guideline through the right internal jugular vein (IJV). PATIENTS AND METHODS The right IJV was cannulated over a period of four months and catheter tip positioning was guided by means of an intracardiac electrocardiogram (ECG). Insertion depth was registered at the position of maximum P wave amplitude and the catheter was fixed after withdrawing 2 cm. Pearson's correlation coefficient was calculated to categorize any relationship between plots of distance versus patient's height, and regression lines and equations were also calculated. Bland-Altman analysis of data was done to compare the old formulae with our derived formulae. RESULTS A total of 155 adult patients were studied. Distances measured were found to be highly correlated with a patient's height, followed by body surface area (BSA) and weight. For right IJV cannulation in valvular surgeries in adults, the depth of insertion (cm) was (height in cm / 15) + 2 ± 1.58 (SD) and in non-valvular surgeries in adults, it was (height in cm/15) + 1.4 ± 1.47 (SD). The bias was very small when the new formulae were compared to the existing formulae. CONCLUSIONS The devised formulae predicted the required depth of catheters thereby reducing the possibility of complications and need for radiographic confirmation.