From the Guidelines
The recommended length of insertion for a CVC in the left internal jugular vein (LIJV) is at least 20 cm, as suggested by the Association of Anaesthetists of Great Britain and Ireland: Safe Vascular Access 2016 1. This guideline provides a general recommendation for the minimum selection length of fixed-length catheters for adults, which is 20 cm for the left internal jugular or right axillary/subclavian vein. When inserting a CVC in the LIJV, it is essential to consider individual patient factors, such as height, body habitus, and anatomical variations, which may require adjustments to the insertion length. Some key points to consider during insertion include:
- Using ultrasound guidance to improve success rates and reduce complications
- Confirming the position of the catheter with chest radiography to ensure proper placement at the cavoatrial junction
- Avoiding forcing the catheter if resistance is met, as this could cause vessel perforation The Association of Anaesthetists of Great Britain and Ireland: Safe Vascular Access 2016 1 provides a comprehensive guide for safe vascular access, including recommendations for device choice, insertion techniques, and post-insertion care. Key considerations for CVC insertion in the LIJV include:
- Patient diagnosis and intended treatment
- Patient choice and preference
- Selection of devices with the appropriate number of lumens required for planned usage
- Use of smaller diameter devices to reduce vein trauma
- Dedicated lumens for specific uses, such as parenteral nutrition.
From the Research
Length of Insertion for CVC in LIJV
- The optimal length for initial insertion of central venous catheters (CVCs) in the left internal jugular vein (LIJV) has been studied in several research papers.
- According to the study by 2, the recommended depth of insertion for the left internal jugular vein is 18 cm.
- Another study by 3 suggests that the catheters can be fixed at a length of 13-14 cm in males and 12-13 cm in females in the left internal jugular vein to achieve correct positioning.
- A study focused on children by 4 found that the optimal insertion length for the left internal jugular vein can be calculated using the formula 0.072 × height (cm) + 2.113.
- While the studies by 5 and 6 do not provide specific information on the length of insertion for CVC in LIJV, they discuss the use of ultrasound guidance for central venous catheterization and its feasibility in patients with difficult peripheral access.