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"Due to the difficulty in estimating the proper length of a central venous catheter in smaller pediatric patients, placing an 8 cm long catheter in these patients and then trimming the distal tip while on bypass may be the most accurate way to properly position a catheter" Glenski et al (2021).

Pediatric central venous catheter length

Abstract:

Background: Due to excess catheter length, pediatric patients undergoing cardiac surgery frequently have the tip of the central venous catheter trimmed while on bypass to obtain optimal catheter positioning.

Aims: We sought to determine if there is a correlation between the patient’s height or weight and the length of catheter removed. Our secondary aim compared the instances of central line-associated bloodstream infections and venous thromboembolisms between the trimmed and untrimmed catheters.

Methods: This retrospective study included patients having undergone cardiac surgery over a 3-year period who had an 8 cm central venous catheter placed in the right internal jugular vein. Hospital lists of central line-associated bloodstream infections and venous thromboembolisms that occurred were cross referenced with our study patients.

Results: There were 147 cases where the 8 cm central venous catheter was trimmed, which represents 35% of the cases. Of the catheters that were cut, on average 2.17 cm was removed. There is negligible correlation between the length of catheter removed and patient height (r=-0.19, p<0.05). There is negligible correlation between the length of catheter removed and patient weight (r=-0.17, p<0.05). There were no instances of central line-associated bloodstream infections or venous thromboembolisms attributed to the trimmed catheters. Of the 273 untrimmed catheters, there were no instances of an infection and one instance of a venous thromboembolism.

Conclusion: Right internal jugular 8 cm central venous catheters are trimmed during pediatric cardiac surgery, and there is minimal correlation between the length removed and the patient height or weight. Due to the difficulty in estimating the proper length of a central venous catheter in smaller pediatric patients, placing an 8 cm long catheter in these patients and then trimming the distal tip while on bypass may be the most accurate way to properly position a catheter.

Reference:

Glenski TA, Taylor CM, Doyle NM, Erkmann JJ, Huffman JC, Anyaso JC. Trimmed Central Venous Catheters in Pediatric Cardiac Surgery: Does Height or Weight Correlate with the Amount Trimmed? Paediatr Anaesth. 2021 Jun 24. doi: 10.1111/pan.14246. Epub ahead of print. PMID: 34166555.