Tehran University Medical Journal

Background: Central venous catheterization is a procedure that is being performed frequently especially in critical clinical settings. In such conditions, good knowledge of the surface anatomy of venous structures is vital to avoid possible complications which could result in life-threatening situations such as bleeding and pneumothorax. Considering the difference between venous anatomy of children and adults and even among different age groups of children, and the fact that our recent knowledge of anatomy is based on studies performed on non-Iranian population, we decided to evaluate the anatomy of the intrathoracic systemic venous system in adults and children and assess the rate of catheter malposition in children.
Methods: This was a retrospective cross-sectional study performed in Dr. Shariati Hospital and Children Medical Center of Excellence, Tehran, Iran, from April 2016 to August 2019. In our study, the surface location of brachiocephalic vein (BCV) formation, the junction of superior vena cava (SVC) to right atrium and, formation of SVC were examined in 150 contrast-enhanced chest computed tomography (CT) scans in children. They were classified into three groups based on their age (neonates to three years, three to seven years, and seven to ten years). Also, 100 similar CT scans in adults were being studied. The other category which has been evaluated through 130 pediatric X-rays, was the location of the tip of the central venous catheter.

Conclusion: This study indicated the different anatomy of central veins in children and adults which could be a cause for malposed central catheter, so knowing this difference and controlling the tip of the catheter by ultrasound during catheterization could help in avoiding this malpositioning.

Background: Understanding hand structures is necessary to diagnose its diseases and injuries. Several methods have been used to teach the anatomy of this body part. In this article, we introduce a new educational tool and examine the impact of its use in learning anatomy.
Methods: Color images of different layers of hand structures were connected with a spring. On each page, the desired structure was cut and that part could be turned from another direction so that the tool was beyond a booklet and could create a three-dimensional image of the region. In this way, a multi-layered structure was made that looking at each part of it and going to the next part was equivalent to removing a layer from the palm of the hand and observing the layer beneath. After making the educational tool, 280 students who participated in the study were divided into two groups: control (A) and experimental (B). Both groups participated in a pre-test. After teaching the theory of hand anatomy for both groups, the control group received practical training using the traditional method and the experimental group using the proposed educational tool, and both groups participated in a post-test and the scores of the pre and post-test groups were compared. Data were analyzed using SPSS 24 statistical software using Mann-Whitney and Wilcoxon tests.