DEPTH OF CENTRAL VENOUS CATHETER INSERTION IN ADULTS - AN AUDIT AND ASSESSMENT OF A TECHNIQUE TO IMPROVE TIP POSITION

A technique of subclavian vein catheterization is described, tailored to the individual patient, to reduce the risk of right atrial placemen t with central venous catheter (CVC) insertion. Using data gathered re trospectively for Quality Improvement purposes, CVC tip location was a ssessed. The standard technique used in our cardiac anaesthesia unit a t that time was to insert all CVCs to a depth of 15 cm from the skin. We then compared CVC tip location using a new ''tailored'' technique. The tailored method involved measuring the distance from the skin at w hich venepuncture occurred and using this distance to determine depth of CVC insertion. Using the tailored technique significantly decreases the frequency with which CVC tips enter the right atrium (P < 0.001). An advantage of the tailored technique is that the distance between t he most proximal and the distal ports of multi-lumen CVCs is taken int o consideration reducing the risk of extravasation via the proximal po rt.