Abstract:

Background: Methods to determine the optimal insertion depth of ultrasound-guided supraclavicular approach to the subclavian vein (SCV) catheterization, alternatively used for central venous access, are debatable in children.

Aim: We investigated the applicability and reliability of the modified formula for determining the depth of SCV catheterization using an ultrasound-guided supraclavicular approach in children.

Methods: This prospective observational study included 36 children (age < 6 years; weight ≥ 5 kg) scheduled to undergo congenital heart disease surgery. After intubation, ultrasound-guided supraclavicular approach to the SCV catheterization was performed. Actual insertion depth was determined by real-time transesophageal echocardiography. Insertion depth was calculated by subtracting 1 cm from the sum of the distance from the insertion point to the sternal head of the right clavicle and that from the latter point to the midpoint of a perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples.

Results: Insertion depth calculated with the modified formula and actual insertion depth of the SCV catheter correlated strongly (r = 0.806, 95% confidence interval [CI]: 0.658-0.908; P < 0.001.). Bland-Altman analysis showed a mean bias and precision of 0.36 and 0.65 cm, respectively (95% CI: 0.14-0.58, 95% limits of agreement: -0.92, 1.64). All plots were above the -1.0 line, indicating no catheter tip insertion into the right atrium.

Conclusions: Optimal insertion depth for an ultrasound-guided supraclavicular approach to the SCV catheterization can be calculated using modification of a surface landmark formula in children younger than 6 years and weight heavier than 5 kg.

Reference:

Ye P, Tan Y, Shi S, Liu L. Optimal insertion depth of subclavian vein catheterization via the right supraclavicular approach in children. Paediatr Anaesth. 2020 Dec 17. doi: 10.1111/pan.14107. Epub ahead of print. PMID: 33336473.