The optimal length of insertion of central venous catheters for pediatric patients

Incorrect positioning of central venous catheters (CVC) in infants and chil dren may lead to serious complications such as perforation of the heart or great vessels. CVC position is not usually assessed until the first postope rative chest radiograph, potentially leaving malposition undetected for sev eral hours. We studied a series of 452 right internal jugular and subclavia n catheter placements in infants and children undergoing surgery for congen ital heart disease, and measured the distance from the skin insertion site to the radiographic junction of the superior vena cava and right atrium (RA ). Based on these data, the following formulae predict that a CVC will be p ositioned above the RA 97% of the time: correct length of insertion (cm) = (height in cm/10) - 1 for patients less than or equal to 100 cm in height, and (height in cm/10) - 2 for patients > 100 cm in height. Weight-based rec ommendations were also developed which predict placement of CVC above the R A 98% of the time.