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P.A. Stonelake, A.R. Bodenham  British Journal of Anaesthesia 

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Presentation on theme: "P.A. Stonelake, A.R. Bodenham  British Journal of Anaesthesia "— Presentation transcript:

1 The carina as a radiological landmark for central venous catheter tip position 
P.A. Stonelake, A.R. Bodenham  British Journal of Anaesthesia  Volume 96, Issue 3, Pages (March 2006) DOI: /bja/aei310 Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

2 Fig 1 Details of CVCs audited. CVC, central venous catheter; PAFC, pulmonary artery floating catheter; IJ, internal jugular; innom, innominate vein; sub, subclavian vein. British Journal of Anaesthesia  , DOI: ( /bja/aei310) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

3 Fig 2 Distance of CVC tip from carina. IJ, internal jugular; SUB, subclavian. British Journal of Anaesthesia  , DOI: ( /bja/aei310) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

4 Fig 3 Scattergraph of catheter tip position and angle to the vertical. Each point represents an individual catheter tip. British Journal of Anaesthesia  , DOI: ( /bja/aei310) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

5 Fig 4 Portable CXR in a critically ill patient shows two CVCs in situ, both inserted from the left internal jugular vein. One is a standard multilumen catheter and the other is a dialysis catheter. The tip of the former is poorly positioned at the junction of the innominate vein and SVC. The stiffer larger bore dialysis catheter is in an even worse position, abutting and tenting the wall of the SVC at an acute angle with significant risk of pain, thrombosis, infection, perforation, and malfunction. See text for further explanation. British Journal of Anaesthesia  , DOI: ( /bja/aei310) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

6 Fig 5 Stylized anatomical figure dividing the great veins and upper RA into three zones (A–C), representing different areas of significance for placement of CVCs. See text for further description. Zone A, upper RA and lower SVC; Zone B, upper SVC and junction of left and right innominate veins; Zone C, left innominate vein. British Journal of Anaesthesia  , DOI: ( /bja/aei310) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

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