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网友[西门吹血]：

近日搜索文献，有报道成人置管深度：颈内静脉穿刺上腔静脉置管的长度右侧为8cm+K，左侧为11cm+K，K为穿刺点至锁骨头上缘距离（cm）。但是对于小儿的置管深度不甚了解。

网友[ximingchen]：

1、颈内静脉导管尖端位于上腔静脉的上半部份最为适宜。此部分上腔静脉位于心包反摺线之上，即使发生静脉壁穿孔，也不至于发生心包填塞的危险。

2、经食道超声心动图技术有助于术中即刻观察到中心静脉导管的位置。

3、经右颈内静脉中心静脉导管的正确位置可按身高进行预测：
（1）身高<100cm，置管深度（cm）=身高(cm)/10-1；
（2）身高>100cm，置管深度（cm）=身高(cm)/10-2。

4、可采用心电图引导中心静脉导管置管的深度。
　　
右侧颈内静脉
____________________________
患儿体重（kg） 置管深度（cm）
____________________________
　2～2.9　　　　　　4
　3～4.9　　　　　　5
　5～6.9　　　　　　6
　7～9.9　　　　　　7
　10～12.9　　　　　8
　13～19.9　　　　　9
　20～29.9　　　　　10
　30～39.9　　　　　11
　40～49.9　　　　　12
　50～59.9　　　　　13
　60～69.9　　　　　14
　70～79.9　　　　　15
　80～100 　　　　　16
____________________________

网友[西门吹血]：

The Optimal Length of Insertion of Central Venous Catheters for Pediatric Patients

Dean B. Andropoulos, MD, Sabrina T. Bent, MD, Barbara Skjonsby, RN, and Stephen A. Stayer, MD

Incorrect positioning of central venous catheters (CVC) in infants and children may lead to serious complications such as perforation of the heart or great vessels. CVC position is not usually assessed until the first postoperative chest radiograph, potentially leaving malposition undetected for several hours. We studied a series of 452 right internal jugular and subclavian catheter placements in infants and children undergoing surgery for congenital heart disease, and measured the distance from the skin insertion site to the radiographic junction of the superior vena cava and right atrium (RA). Based on these data, the following formulae predict that a CVC will be positioned above the RA 97% of the time: correct length of insertion (cm) = (height in cm/10) - 1 for patients 100 cm in height, and (height in cm/10) - 2 for patients >100 cm in height. Weight-based recommendations were also developed which predict placement of CVC above the RA 98% of the time.

IMPLICATIONS: This study assessed central venous catheter placement in 452 infants and children undergoing cardiac surgery. Simple, clinically useful guidelines based on height and weight were developed to prevent malposition of these catheters, which may cause serious complications such as perforation of the heart or great vessels.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11574350


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