The carina as a landmark in central venous catheter placement

Location of the tip of a central venous catheter (CVC) within the pericardi um has been associated with potentially lethal cardiac tamponade. Because t he pericardium cannot be seen on chest x-ray (CXR), an alternative radiogra phic marker is needed for correct placement of CVCs. The anatomy of the reg ion was studied in 34 cadavers. The carina was a mean (SEM) distance of 0.4 (0.1) cm above the pericardial sac as it transverses the superior vena cav a (SVC). In no case was the carina located below the pericardial sac. The c arina is a reliable, simple anatomical landmark for the correct placement o f CVCs. In almost all cases, the carina is radiologically visible even in p oor quality, portable CXRs. CVC tips should be located in the SVC above the level of the carina in order to avoid cardiac tamponade.