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The pericardial reflection and the tip of the central venous catheter — topographical analysis in stillborn babies

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Abstract

Background

Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium.

Objective

To investigate the level of the superior pericardial reflection in stillborn babies.

Materials and methods

We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25–43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium.

Results

Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5).

Conclusion

The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space.

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Authors and Affiliations

  1. Department of Pediatric Critical Care Medicine and Neonatology, University Children’s Hospital, Kerpener Strasse 62, 50926, Cologne, Germany

    Frank Eifinger, Anne Vierzig & Bernhard Roth

  2. Institute of Anatomy II, University of Cologne, Kerpener Strasse 62, 50926, Cologne, Germany

    Martin Scaal

  3. Department of Radiology, University of Cologne, Kerpener Strasse 62, 50926, Cologne, Germany

    Friederike Koerber

Authors
  1. Frank Eifinger
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  2. Anne Vierzig
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  3. Bernhard Roth
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  4. Martin Scaal
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  5. Friederike Koerber
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Correspondence to Frank Eifinger.

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Eifinger, F., Vierzig, A., Roth, B. et al. The pericardial reflection and the tip of the central venous catheter — topographical analysis in stillborn babies. Pediatr Radiol 46, 1528–1531 (2016). https://doi.org/10.1007/s00247-016-3659-y

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  • DOI: https://doi.org/10.1007/s00247-016-3659-y

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