Appropriate Length and Position of the Central Venous Catheter Insertion via Right Internal Jugular Vein in Children.

Design: Observational study. Setting: Tertiary University Hospital. Participants/patients: Patients, aged 6 days to 19 years, who underwent contrast enhancement computerized tomography imaging of the thorax (CT-thorax). Main outcome measures: We measured three lengths consisting of length A in axial plane at the level of the lower border of the 6th C-spine from the skin to RIJV at its mid lumen, length B and C in sagittal plane from the RIJV at the level of the lower of the 6th C-spine to the superior vena cava (SVC) at carina and from carina to SVC-right atrium junction, respectively. Lengths A plus B represented the length of CVC where the tip was expected in the SVC at carina (CVCcarina). Lengths A plus B and C represented the length of CVC when the tip was expected in the SVC at SVCright atrium junction (CVCSVC-RA). Results: One hundred and sixty-five cases with mean age of 8.1 ± 4.7 years were reviewed. The CVCSVC-RA and CVC carina were significantly correlated with age and body surface area (BSA). Using multiple regression analysis, CVCSVC-RA (cm) was equal to 6.4 + 2.8[BSA (m2)] + 0.022[age (month)] and CVCcasina (cm) equal to 4.9 +2.7[BSA (m2)] +0.013[age (month)] (Adjusted Rsquared 0.7275, 0.7140). Conclusions: We recommended the appropriate CVC length via RIJV approach should be between these two calculated lengths and the CVC length in each age according to the BSA.

Utilization of electron beam CT scan in diagnosis of pulmonary embolism.

Pulmonary embolism is a difficult entity to diagnose clinically and pulmonary angiogram has been the gold standard for the diagnosis. Our objective was to evaluate the usefulness of electron beam (Ultrafast) CT scan in aiding the diagnosis of such an entity, thus avoiding an invasive procedure. Between April 1995 and March 1996 we prospectively studied 20 patients with clinical suspicion of pulmonary embolism by conventional perfusion scan of the lung, by invasive pulmonary angiography and by contrast enhanced electron beam CT scan. Simple statistic correlation between the 3 methods was obtained in regard to sensitivity and specificity utilizing the pulmonary angiogram as the gold standard. The sensitivity and specificity of contrast enhanced electron beam CT scanning was 95 per cent and 100 per cent respectively. The correlation of positive and negative result of all three imaging modalities was 60 per cent. Contrast enhanced electron beam (Ultrafast) CT scan is a good alternative diagnostic modality for pulmonary embolism.