Anesth Pain Med.  2021 Jul;16(3):258-265. 10.17085/apm.21021.

A retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants: landmark-based estimation vs. linear regression model

• Oh C
• Hong B
• Jo Y
• Chung W
• Kim H
• Shin S
• Choi AY
• Lim C
• Ko Y
• Kim YH
• Lee SY

• KMID: 2519054
• DOI: http://doi.org/10.17085/apm.21021

Abstract

Background
The optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year.
Methods
Fifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion.
Results
A landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant.
Conclusion
A simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.

Keyword

Anatomic landmarks; Central venous catheterization; Infant; Pediatrics; Subclavian vein

Figure

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  Fig. 1. Landmark points used in landmark-based models (A) and ultrasound image taken during introducer needle insertion via the infraclavicular approach using an in-plane technique (B). (A) I: insertion point of the needle, A: tip of the sternal head of the right clavicle, B: midpoint of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. (B) A linear ultrasound probe was placed at the supraclavicular level with the clavicle at the center of the view. The probe was directed slightly inferolateral to superomedial direction. The vein indicated in the figure represents subclavian vein joining with the internal jugular vein.

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  Fig. 2. Determination of the optimal insertion length on chest radiograph. The trachea and main bronchus are outlined by a blue solid line. The optimal insertion length was determined by subtracting the vertical distance (V) between the tip and the carina (C) from the actual inserted length. C: level of the carina, V: vertical distance between the catheter tip and the carina, O: optimal position of the catheter tip.

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  Fig. 3. Flow diagram of patient selection.

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  Fig. 4. Bland-Altman plot of determined and estimated optimal insertion lengths (IA + AB – 5). IA: distance from the insertion point (I) to the tip of the sternal head of the right clavicle (A), AB: distance from point A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples.

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  Fig. 5. Bland-Altman plot of determined and estimated optimal insertion lengths (linear regression model).

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