Clinical study
CT Angiography of the Superior Vena Cava: Normative Values and Implications for Central Venous Catheter Position

https://doi.org/10.1016/j.jvir.2007.06.002Get rights and content

Purpose

To determine normative data for radiographic landmarks of the superior vena cava (SVC) and the location of the junction of the SVC with the right atrium for use in the placement of central venous catheters.

Materials and Methods

The authors retrospectively reviewed 112 pulmonary computed tomographic (CT) angiograms obtained in seven men and seven women from each decade of life between the ages of 20 and 99 years. For each patient, the length of the SVC was measured from its origin to the cavoatrial junction. The distances from the carina and right tracheobronchial angle to the cavoatrial junction and the origin of the SVC were also measured. Interobserver variation in choosing the location of the carina and tracheobronchial angle was analyzed.

Results

The mean length (±standard deviation) of the SVC was 70.7 mm ± 14.1. The mean distance from the superior margin of the SVC to the carina was 30.4 mm ± 11.2, from the carina to the cavoatrial junction 40.3 mm ± 13.6, from the superior margin of the SVC to the right tracheobronchial angle 21.7 mm ± 10.8, and from the right tracheobronchial angle to the cavoatrial junction 49.0 mm ± 13.6. There was a statistically significant difference in interobserver variation in selecting the location of the right tracheobronchial angle as compared to choosing the carina.

Conclusion

Placement of the central venous catheter tip at or just below the level of the carina during inspiration ensures placement in the SVC. Placement of the central venous catheter tip approximately 4 cm below the carina will result in placement near the cavoatrial junction.

Section snippets

Materials and Methods

This retrospective study was approved by the institutional review board and included a waiver of informed consent. We reviewed 112 pulmonary CT angiograms obtained during maximal inspiration in 56 men and 56 women who were suspected of having acute pulmonary embolism at a single non-profit Health Maintenance Organization hospital. All studies were performed with a four-section CT unit (Lightspeed QXi; GE Medical Systems, Milwaukee, Wis) by using 1.25-mm collimation after the intravenous

Results

The Table presents the data about the length of the SVC and the distances from the right tracheobronchial angle and the carina to the top of the SVC and the cavoatrial junction.

The mean length of the SVC (±standard deviation) was 70.7 mm ± 14.1 (range, 45–117 mm; 95% confidence interval [CI]: 68.1 mm, 73.4 mm). There was a statistically significant difference in the length of the SVC between men and women (75.2 mm ± 15.3 vs 66.2 mm ± 11.2, respectively; P < .001). Multivariate linear regression

Discussion

Optimal positioning of central venous catheters is a complex issue. Historically, radiographs have been used to evaluate for proper placement of central venous catheters on the basis of radiographic landmarks including the right tracheobrochial angle (4, 8), cardiac silhouette (9), and carina (10, 11).

Little normative data exist about the relationships between frequently used anatomic landmarks and the superior and inferior borders of the SVC. Data obtained from MR images or CT scans of

References (12)

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The views expressed herein are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the U.S. Government.

None of the authors have identified a conflict of interest.

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