Central line ..Proper positioning

Proper positioning of Cental line is imperative. Improperly placed tips of catheters can create significant morbidity and in some cases mortality. Specifically, catheter tips located in the right atrium or right ventricle can cause arrhythmias or perforate the heart, leading to tamponade and death. Catheter tips placed too proximally, in the subclavian vein or brachiocephalic vein, are associated with higher rates of thrombus formation and central stenosis.

Central catheters placed in either the subclavian or internal jugular veins should be positioned with the tip at the cavoatrial junction.

The cavoatrial junction is located approximately 5 cm below the tracheobronchial angle, a reliable fluoroscopic landmark.

This distance is reproducible in all patients independent of gender and body habitus. Most central venous catheters are manufactured with marks denoting the length of the catheter.

In general to reach the cavoatrial junction, catheters should be placed at the following lengths:

RIJ ~ 12 cm

LIJ ~ 15 cm

RSC ~ 15 cm

LSC ~ 18 cm.

Proper placement of catheters in both the internal jugular and subclavian veins can be confirmed using a chest x-ray or with fluoroscopy.

Central catheters placed in the femoral vein should have the tip located at the confluence of the left and right iliac veins. The third lumbar vertebral body approximates this location, which can be confirmed on pelvic x-ray.

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