Appropriate Length and Position of the Central Venous Catheter Insertion via Right Internal Jugular Vein in Children

indicated in patients in pediatric intensive care units for medications, volume replacement, parenteral nutrition, obtaining blood sampling, hemodialysis vascular access, or central venous pressure (CVP) monitoring. Regardless of the indications, the position of the CVC tip is important to avoid potential serious complications, including pneumothorax, hemothorax, pericardial effusion leading to cardiac tamponade, cardiac perforation, or arrhythmias due to irritation to the endocardium [1,2]. Some guidelines recommended that the CVC tip should be positioned in the superior vena cava (SVC) above the level of the pericardial reflection to be certain that it is outside the pericardium [3-6]. Studies proposed that the carina was a reliable and simple radiographic marker for the position of the CVC tip, based on the examination of either embalmed or fresh cadavers [4-8]. Some recommended that the CVC tip should be placed just above the superior vena cava and right atrium (SVC-RA) junction to avoid malposition and CVC tip perforation [911]. The length of CVC insertion from skin to SVC at the level of the carina or to SVC at SVC-RA junction, using right internal jugular vein (RIJV) approach may be varied Appropriate Length and Position of the Central Venous Catheter Insertion via Right Internal Jugular Vein in Children