Predicting Central Venous Catheter Insertion Length from Body Surface Area in children
Michael Paul, MD, David P. Mooney, MD, MPH, Sarah Tracy, BA, David Zurakowski, PhD, Jill Zalieckas, MD
PURPOSE OF STUDY
Optimal central venous catheter tip location is necessary to lessen complications related to their use. Determining the optimal length of catheter to insert via the subclavian approach would seem to be a simple maneuver, but is more fraught with error in children. In order to help determine the appropriate catheter length, we aimed to derive a formula useful to surgeons in the Operating Room.
Records of 727 consecutive children who underwent central venous catheter insertion by either the left (514) or right (213) subclavian approach were retrieved from a departmental database. Patient demographics, including age, gender, height and weight were retrieved. Post-placement chest radiographs were reviewed and the length of catheter required to reach the right atrial-superior vena caval junction was measured using a freehand ruler function. Radiographs were corrected for the amount of inspiration. A linear regression model was fit to predict the optimal catheter length.
SUMMARY OF RESULTS
Children ranged from 3 months to 21 years of age (55% male). Body weight ranged from 3.2 to 126.9 kilograms and body surface area (BSA) from 0.20 to 2.46. The formulas for optimal catheter length were 6.4 x BSA + 7.1 cm for the left subclavian approach and 5.2 x BSA + 5.9 cm for the right. Using these formulas to determine the length of tubing to insert, over 95% of catheters would fall within 2 cm of the optimal length.
Simple to use formulas may assist in determining the optimal length of catheter to insert during subclavian CVL placement in children.