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The carina is not a landmark for central venous catheter placement in neonates
Author(s) -
INAGAWA GAKU,
KA KOUI,
TANAKA YUKICHI,
KATO KEISUKE,
TANAKA MIO,
MIWA TAKAAKI,
MORIMURA NAOTO,
KOYAMA YUKIHIDE,
HIROKI KOICHI
Publication year - 2007
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2007.02258.x
Subject(s) - medicine , pericardium , tamponade , cardiac tamponade , superior vena cava , gestational age , central venous catheter , autopsy , anatomy , cadaver , surgery , catheter , pregnancy , genetics , biology
Summary Background: Cardiac tamponade is rare but one of the most serious complications in relation to central venous catheters (CVC). The tip of the CVC should be placed outside the pericardium to avoid tamponade. In adults, the carina is always located above the pericardium; therefore, the carina is a reliable landmark for CVC placement. We examined whether the carina could also be an adequate landmark for CVC placement in neonates. Methods: The study was conducted using nine fresh neonatal cadavers. The longitudinal distance between the carina and the pericardium as it transverses the superior vena cava (the pericardial reflection: PR) was measured. Results: The median postconceptional age (gestational age in weeks + weeks after delivery) at autopsy was 35 (range: 23–42) weeks. The PR was located at a distance of 4 mm above to 5 mm below the carina. Unlike in adults, the position of the PR varies in relation to the carina in neonates. In seven of the nine subjects, the location of the PR was above the carina. Conclusions: In neonates, the carina is not always located above the pericardium, as it is in adults; therefore, the carina is not an appropriate landmark for CVC placement.