Optimal Central Venous Catheter Placement

 Confirm that the catheter is placed correctly in the vein and that the tip is in the desired position using a chest radiograph. Ideally, the tip of the catheter should be roughly parallel with the wall of the superior vena cava, caudal to the inferior margin of the clavicle, between the third rib and the fourth/fifth thoracic vertebra, and cranial to the bifurcation of the trachea or right primary bronchus (see Fig ).

The bifurcation of the trachea is usually positioned cranial to the pericardial reflection; thus, it is best if the tip of the catheter is always cranial to this. If perforation due to erosion of the vessel wall occurs, a mediastinal hematoma may occur, transfusion fluid may enter the chest cavity cranial to the pericardial reflection, or cardiac tamponade may occur caudal to this area.

Optimal catheter placement. Zone A, inferior portion of the superior vena cava up to the superior portion of the right atrium; zone B, portion of the right innominate vein confluent with the left innominate vein and the superior portion of the superior vena cava; zone C, innominate vein peripheral to the superior vena cava.

Source: Safety Committee of Japanese Society of Anesthesiologists