Depth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position.

A technique of subclavian vein catheterization is described, tailored to the individual patient, to reduce the risk of right atrial placement with central venous catheter (CVC) insertion. Using data gathered retrospectively for Quality Improvement purposes, CVC tip location was assessed. The standard technique used in our cardiac anaesthesia unit at that time was to insert all CVCs to a depth of 15 cm from the skin. We then compared CVC tip location using a new "tailored" technique. The tailored method involved measuring the distance from the skin at which venepuncture occurred and using this distance to determine depth of CVC insertion. Using the tailored technique significantly decreases the frequency with which CVC tips enter the right atrium (P < 0.001). An advantage of the tailored technique is that the distance between the most proximal and the distal ports of multi-lumen CVCs is taken into consideration, reducing the risk of extravasation via the proximal port.