Calculating CVC length in pediatric patients
Purpose: Placement of a central venous catheter (CVC) is the most commonly performed pediatric procedure. This study aims to develop simple formulas to calculate intravascular length of CVCs prior to insertion to minimize reliance on fluoroscopic and radiographic imaging, which may not be uniformly available.
Methods: We performed a single-institution, retrospective review of 115 pediatric patients who received both CVC placement and computed tomography (CT) imaging of the chest within 3 months of the procedure. Using measurements from the CT imaging, formulas calculating the length of the intravascular component of the CVC based on height and insertion laterality were developed and compared to previously published formulas. These formulas were then trialed prospectively to validate reliability and application.
Results: Formulas were developed for right-sided and left subclavian insertion. The right-side formula accurately predicted CVC length in 52.6% of patients, compared to 47.4% by the Andropoulos formula. The left subclavian formula accurately estimated 62.5%, compared to 34.5% by the Stroud formula.
Conclusions: The optimal intravascular length of central venous catheters may be determined by simple formulas based on patient height and insertion site.
Level of evidence: III.
Ross AB, Gomez-Quevedo O, Sutthatarn P, Lu Z, Wang X, Prajapati H, Talbot LJ, Davidoff AM, Murphy AJ, Abdelhafeez AH. A CT scan-based formula for predicting central venous catheter length in pediatric patients. Pediatr Surg Int. 2022 Jul 18. doi: 10.1007/s00383-022-05165-4. Epub ahead of print. PMID: 35849175.