Central venous catheters—the inability of ‘intra-atrial ECG’ to prove adequate positioning

Schummer, Wolfram; Schummer, Claudia; Schelenz, C; Brandes, Harald; Stock, Ulrich A.; Muller, Thierry; Leder, U.; Hüttemann, E.

doi:10.1093/bja/aeh191

Cited by 50 publications

(33 citation statements)

References 16 publications

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“…In another study, Schummer et al (17) demonstrate that intraatrial ECG is not reliable for detecting whether a central catheter is positioned IV or intraarterially. According to their data, it is questionable whether the elevation in the P-wave (P-atriale) is caused by the RA or rather by the pericardial reflection.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of Electrocardiogram-Controlled Central Line Placement

Gebhard¹,

Szmuk²,

Pivalizza³

et al. 2007

Anesthesia & Analgesia

106

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Section: Discussionmentioning

confidence: 99%

The Accuracy of Electrocardiogram-Controlled Central Line Placement

Gebhard¹,

Szmuk²,

Pivalizza³

et al. 2007

Anesthesia & Analgesia

106

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“…26 In addition, conductance is more direct than other nonfluoroscopic PICC navigation and tip location technologies such as electrocardiographic, Doppler flow, and stylet-aided magnetic guidance. [14][15][16][17][18][19][20] Electrocardiographic and Doppler flow methods have been controversial and not widely adopted in the clinic, while stylet-aided magnetic guidance provides a nonanatomically based relative assessment of PICC position. These and other bedside guidance technologies (eg, SwanGanz catheters 27 ) exist and rely on physiological measurements to confirm catheter location.…”

Section: Discussionmentioning

confidence: 99%

Accurate nonfluoroscopic guidance and tip location of peripherally inserted central catheters using a conductance guidewire system

Svendsen

Birrer

Jansen

et al. 2013

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…Some authors suggested that an increase in the P-wave amplitude already starts at the pericardial reflection outside the heart and ECG guidance cannot distinguish whether a catheter is placed intraarterially or intravenously 11,26. Fluoroscopy or transesophageal echocardiography may be more reliable methods to detect the position of central venous catheters.…”

Section: Discussionmentioning

confidence: 99%

External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

et al. 2009

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Central venous access plays an increasingly important role in the delivery of modern care. Many studies on the venous access sites for central venous catheterization have been conducted. [1][2][3][4][5] The preferred access site for central venous catheter placement continues to be the right internal jugular vein (IJV).When the right IJV is not available for central venous access, the second access site remains variable. Although the left IJV and the subclavian veins (SCV) have been used for second access, several studies suggest that both SCVs and the left IJV should be avoided because of a high incidence of procedural complications (pneumothorax, arterial puncture) as well as central venous stenosis and thrombosis. [2][3][4][5][6] The left IJV is also related with a high incidence of catheter malfunction. 6 Some authors believe that the second venous access after the right IJV should be the right external jugular vein (EJV). 3,7 One reason for use of the right EJV is its relatively straightforward course and short length, which are very similar to those of right IJV. A second reason is that the EJV is easily accessed, given its superficial location on the neck.7 However, it is suggested that the incidence of malpositioned catheters via the EJV approach makes this route unreliable. 8 To decrease the incidence of catheter dislodgement, vessel wall erosion, thromboembolism and catheter malfunction, accurate positioning of the catheter tip near or at the junction of the superior vena cava (SVC) and right atrium (RA) is necessary.9 It is possible to decrease the incidence of malposition with the use of additional techniques. French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava. Results: In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation. Conclusion: Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.

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Central venous catheters—the inability of ‘intra-atrial ECG’ to prove adequate positioning

Abstract: The start of an increase in P wave size does not correspond with the entrance of the right atrium. The anatomic equivalent for the electrophysiological changes of the ECG is the pericardial reflection. ECG guidance is unable to distinguish between venous and arterial catheter position.

Cited by 50 publications

References 16 publications

The Accuracy of Electrocardiogram-Controlled Central Line Placement

The Accuracy of Electrocardiogram-Controlled Central Line Placement

Accurate nonfluoroscopic guidance and tip location of peripherally inserted central catheters using a conductance guidewire system

External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

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