Quest to determine the ideal position of the central venous catheter tip

<span class="paragraphSection">Central venous cannulation is a standard practice for any major surgery and intensive care unit admission entailing major haemodynamic effects, blood loss, administration of fluids and vasoactive drugs, and central venous pressure monitoring.<a href="#aew443-B1" class="reflinks">¹</a> The internal jugular vein (IJV) or subclavian vein is the preferred route for this purpose. Hitherto, the practice regarding the length of insertion of the central venous catheter (CVC) has not conformed to any fixed guidelines.<a href="#aew443-B2" class="reflinks">²</a> One of the dreaded complications of CVC placement is cardiac tamponade as a result of perforation of the vessel or the cardiac chamber, which carries a high mortality.<a href="#aew443-B3" class="reflinks">³</a><a href="#aew443-B4" class="reflinks">⁴</a> The US Food and Drug Administration recommends that the CVC tip should not be located in or allowed to migrate into the heart to avert this catastrophic complication.<a href="#aew443-B5" class="reflinks">⁵</a> Owing to this, it is believed that the tip of the catheter should be placed in the middle superior vena cava (SVC), outside the pericardial reflection enveloping the lower SVC. This corresponds to the level of the carina, ∼2 cm above the junction of the SVC and the right atrium (RA).<a href="#aew443-B2" class="reflinks">²</a><a href="#aew443-B4" class="reflinks">⁴</a><a href="#aew443-B6" class="reflinks">⁶</a></span>

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