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J Korean Soc Emerg Med > Volume 20(6); 2009 > Article
Journal of The Korean Society of Emergency Medicine 2009;20(6): 635-641.
Usefulness of Tip-to-Carina Distance as a Marker for Detecting Right Atrium Positioning of a Central Venous Catheter on Chest X-Ray
Joon Min Park, Tae Nyoung Chung, Min Joung Kim, Sun Wook Kim, Yoo Seok Park, Sung Pil Chung, Seung Ho Kim
Department of Emergency Medicine, Yonsei University, College of Medicine, Seoul, Korea. hendrix74@gmail.com
ABSTRACT
PURPOSE:
Our goal was to check the effect of physique on tip-to-carina (TC) distance for detecting the right atrium (RA) position of a central venous catheter tip, and to determine the optimal cut-off value for TC distance.
METHODS:
We did a retrospective review of patients who were given chest computed tomography within 12 hours after central venous catheterization (CVC) between September 2005 and February 2009. We used electronic medical records (EMR) and a picture archiving communication system (PACS). TC/height ratio and TC/thoracic width ratio were used as height and thoracic width corrected TC distances. We developed receiver operating characteristic (ROC) curves for TC distance, TC/height and TC/thoracic width, and compared the area under curves (AUCs) of each. An optimal cut-off value for TC distance was obtained using ROC curves.
RESULTS:
A total of 88 patients were enrolled in our study to determine the optimal cut-off value for TC distance. Of the 88, records for 64 included height, which was required for comparing TC with height and thoracic width corrected TC. AUCs of TC, TC/height, and TC/thoracic width were, respectively, 0.966, 0.962, 0.970. There was no statistically significant differences between them. The cut-off value for TC distance for detecting RA positioning of a CVC is 30 mm (Sensitivity = 100%, Specificity = 85.1%).
CONCLUSION:
TC distance is a useful marker for detecting RA positioning of a CVC regardless of the patient's height and thoracic width. We suggest 30 mm as the optimal cutoff value for TC distance.
Key words: Catheterization, Central venous, Radiography, Thoracic, Methods
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