November 29, 2025
Background: Children undergoing major surgery or critical illness often require placement of a central venous catheter (CVC). Accurate positioning of the CVC tip at the cavoatrial junction, where the distal superior vena cava meets the right atrium, is essential to minimize complications. Transthoracic echocardiography (TTE) can be used to guide CVC tip placement, although its accuracy has traditionally been evaluated against chest X-ray, which cannot directly identify the cavoatrial junction.
Aims: To determine whether TTE can accurately guide CVC tip placement at the cavoatrial junction during catheter insertion in children. The primary hypothesis was that TTE-guided positioning would achieve correct CVC tip placement, confirmed by transesophageal echocardiography (TEE), in at least 90% of children.
Methods: This prospective observational study included children aged 0-14 years undergoing elective surgery for congenital heart disease. The primary endpoint was the proportion of children with correct CVC tip placement at the cavoatrial junction using TTE guidance, with TEE serving as the reference standard.
Results: A total of 150 children were analyzed. TTE-guided CVC tip positioning achieved correct placement at the cavoatrial junction in 136 children (91%; 95% confidence interval: 85%-94%). The success rate was highest in children aged 0-3 months (96%) and lowest in those aged 13-14 years (70%).
Conclusions: TTE-guided CVC tip positioning achieved correct placement at the cavoatrial junction, confirmed by TEE, in 91% of children. TTE should be considered for guiding CVC tip placement during catheter insertion in pediatric patients, particularly in younger children.
Trial Registration: German Clinical Trial Register: DRKS00028271.
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