Optimising central venous catheter placement by comparing cavoatrial junction position to chest X-ray landmarks: A cross-sectional study using CT chest reconstruction

IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Medical Imaging and Radiation Oncology Pub Date : 2024-08-29 DOI:10.1111/1754-9485.13741
Mayooran Kandasamy, Stanley Xue, Nigel McGregor, Hao Xiang
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Abstract

Introduction

Central venous catheter (CVC) tip placement guided by chest X-ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X-ray landmarks.

Methods

Chest CTs of 100 patients were retrospectively assessed. CT images were converted to a ‘virtual CXR’ using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes.

Results

The mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup-RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat-RHB) was 18.4 mm below the CAJ. A new landmark: the mid-superior right heart border, defined as the mid-point between the Sup-RHB and Lat-RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ.

Conclusion

We propose that the CVC tip can be placed at the mid-superior right heart border landmark.

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通过将腔房交界位置与胸部 X 光地标进行比较,优化中心静脉导管的放置:使用 CT 胸部重建的横断面研究。
导言:目前,在胸部 X 光(CXR)地标的引导下放置中心静脉导管(CVC)尖端容易出现不一致和定位错误的情况。本研究旨在更好地界定腔房交界处(CAJ)与选定 X 光标志物之间的关系:方法:对 100 名患者的胸部 CT 进行回顾性评估。使用数字工作站将 CT 图像转换为 "虚拟 CXR",以便同时定位 CAJ 和评估 CXR 标志。对每位患者的 CAJ 与所选地标之间的垂直距离进行了测量。测量结果与年龄相关,并在不同年龄组和性别之间进行比较:结果:CAJ上方以下地标的平均垂直距离为:心尖(46.2 毫米)、中间支气管与右心边界交点(7.6 毫米)和右心边界上拐点(Sup-RHB)(13.0 毫米)。右心边界(Lat-RHB)的最大外侧隆起位于 CAJ 下方 18.4 毫米处。一个新地标:右心室中上边界(定义为Sup-RHB和Lat-RHB之间的中点)最接近CAJ,位于CAJ下方2.6毫米处:结论:我们建议将 CVC 头端放置在右心前缘中点。
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来源期刊
CiteScore
3.30
自引率
6.20%
发文量
133
审稿时长
6-12 weeks
期刊介绍: Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.
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