Radiological landmarks for optimal tip-position of the central venous port catheter inserted via peripheral vein in the left arm

The purpose of this study was to investigate normative data of the superior vena cava (SVC) anatomy using multi-detector row CT (MDCT) and determine the optimal tip-position of the central venous port catheter inserted via the peripheral veins in the left arm. On the coronal images of MDCT in 48 patients as a control, the SVC length and distances between the carina and cavoatrial junction and between the cephalad margin of SVC and carina were measured using a workstation. The location of a catheter-tip in twenty-three patients with a central venous port catheter inserted via a peripheral veins in the left arm was categorized into two groups: group A (above or same level as the carina, n=14), group B (below the carina, n=9). We investigated catheter-related complications such as catheter dislodgement and venous thrombosis. According to the MDCT images in the control group, the mean distance from the carina to the cavoatrial junction was 35.3 mm±7.4 mm (95% confidence interval [CI]; 30 mm, 40.6 mm). The mean distance from the cephalad margin of the SVC to the carina was 28.5 mm±5.6 mm (95% CI; 24.5 mm, 32.5 mm). The catheter tip was dislodged into the left innominate vein in seven patients of group A, and venous thrombosis was seen in two of these patients. No significant complications in group B (26.8 mm±7.6 mm below the carina, 95% CI; 21.8 mm, 31.8 mm) were seen. The position at approximately 3-4 cm below the carina is near the cavoatrial junction. The optimal tip-position of the central venous port catheter should be 2-3 cm below the carina. (author)