成人中央靜脈導管位置(Central venous catheter tip position)

Case courtesy of Dr Henry Knipe, Radiopaedia.org. From the case rID: 29717

大部分成人置放中央靜脈導管，初學者常有暨左邊脖子放16公分、右邊20公分等等，等照完胸部x光再來調整。

導管尖端位置

有文獻探討中央靜脈導管導管放入深度讓導管尖端在上腔靜脈下端或右心房入口處上方(在pericardial reflection上方)。

參考公式

臨床上可考慮用公式如下(身高Ht, cm)，或稱Peres 公式(Peres's formula)：

右內頸靜脈：(Ht/10)-1 cm（原公式Ht/10cm）
左內頸靜脈：(Ht/10)+4 cm

右鎖骨下靜脈：(Ht/10)-2 cm
左鎖骨下靜脈：(Ht/10)+2 cm

胸部X光

透過胸部X光的心臟右上邊緣來估算右心房位置是不準的，但透過氣管(carina)和右right tracheobronchial angle的交界來定位導管位置，而這位置在pericarial reflection的上方(代表不會在pericadial sac附近而傷到傷到血管而導致cardiac tamponade)。

參考資料

1. UptoDate: Placement of subclavian venous catheters
2. Christine A. Czepizak, et al. Evaluation of Formulas for Optimal Positioning of Central Venous Catheters. Clinical Investigations in Critical Care. Volume 107, Issue 6, June 1995
3. Peres PW. Positioning central venous catheters--a prospective survey. Anaesth Intensive Care. 1990
4. Aslamy Z. et al. MRI of central venous anatomy: implications for central venous catheter insertion. Chest. 1998
5. Kim WY, et al. Optimal insertion depth of central venous catheters--is a formula required? A prospective cohort study. Injury. 2012 Jan;43(1):38-41. doi: 10.1016/j.injury.2011.02.007.
6. Broderick LS, et al. Anatomic pitfalls of the heart and pericardium. Radiographics. 2005 Mar-Apr;25(2):441-53. doi: 10.1148/rg.252045075.
7. Schuster M1, et al. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000 
8. Albrecht K1,, et al. Applied anatomy of the superior vena cava-the carina as a landmark to guide central venous catheter placement. Br J Anaesth. 2004