| Objective:The purpose of the study was to find out the optimal anatomic landmarks of central venous catheter position with two approaches on chest radiography based on CT.And on this basis to use the basic clinical data of patients to predict the length of the catheter.Methods:A total of 585 patients or physical examiners who underwent chest CT scan in the CT room of the First Hospital of Shanxi Medical University from August 2019 to January 2020 were collected.1.Picked the minimum out of all recorded distance data of relevant landmarks to the origin of superior vena cava(SVC)and SVC-the cavoatrial junction(CAJ)respectively.2.Chose the landmark overlap the bottom 1/3 segment of SVC most frequently among all corresponding ones.All above data were measured by counting axial slices according to CT scout imaging.In addition,354 chest radiographs were randomly selected from the radiology department of the First Hospital of Shanxi Medical University from August 2019 to December 2019,and 258 patients were enrolled to meet the measurement requirements.The distance between the lower margin of the right sternoclavicular joint and the hilar Angle was measured and recorded.Fetch the patient record system to document gender,age,height,weight and calculate body mass index.All data were analyzed by SPSS25.0 statistical software.Mann-Whitney U rank sum test was used for measurement data that did not follow normal distribution,and Kruskal-Wallis H rank sum test was used for measurement data of multiple groups.The sample rates were compared byχ~2 test.Spearman correlation analysis was used to analyze the relationship between the above five basic indexes and the distance between the lower margin of the right sternoclavicular joint and right hilar Angle.Multivariate linear regression analysis was carried out on those with relevant relationships in the previous analysis to establish a regression model.P<0.05 was used to determine the difference.Results:1.Discrepancy between inferior margin of T4 vertebra and origin of SVC approached minimum compared to others within this group(χ~2=1487.915,P<0.001);The right superior heart border were closer to CAJ than any other associated landmarks(χ~2=1115.905,P<0.001).2.Right hilar angle overlapped most frequently with the bottom 1/3 segment of SVC amid all equivalents(χ~2=2395.428,P<0.001).3.The correlation analysis results of height(X2),stature(X3)and the lower margin of the right sternoclavicular joint--the right hilar angle spacing distance(Y)were P<0.05,and the correlation coefficients were 0.739 and 0.367,respectively,showing significant correlation at the level of 0.05 confidence.The results of multiple linear regression analysis showed statistical significance within a 95%confidence interval.The regression model is Y=17.792*X2-0.015*X3-15.520.Conclusion:1.Inferior margin of T4 and right superior heart border turned out to be the most approximate landmarks to origin of SVC and CAJ separately.On chest radiographs,both markers can be used to estimate the range of the lower 1/3 of SVC,to determine the location of the tip of the central venous catheter.2.Right hilar angle represented the optimal position of central venous catheter best amid all matching landmarks.3.Before placing the catheter,the patient’s recent chest radiographs could taken as reference,and it was more reasonable to replace"the lower margin of the right sternoclavicular joint--the lower margin of the right third anterior costal joint spacing distance"in the"transverse L method"with"the lower margin of the right sternoclavicular joint--the right hilar angle spacing distance".Right sternoclavicular joint lower margin-right 3rd anterior costal lower margin spacing4.If the patient could not provide previous chest radiographs before catheterization,the distance between the lower margin of the right sternoclavicular joint and the right hilar angle can be calculated according to the regression model studied in this paper to forecast the length of the catheter. |
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