CVP catheter electrocardiography: an alternative to radiographic control after cannulation of central veins?

Abstract

We evaluated 160 electrocardiograms taken after placement of central venous catheters (CVC) to determine their locations. Usable recordings were obtained in 154 patients. Subsequent radiographs revealed 30 misplaced catheters. Twenty-five of those were detected by CVC electrocardiograms. There were five false positive and five false negative traces. The sensitivity of CVC electrocardiography was 96%, the specificity 83.3%, and the total predictive power 93.5%. Electrocardiograms obtained from guide-wires were of significantly better quality than those from 0.9% NaCl filled catheters. The technique is accurate, safe and easy to learn. It may reduce the need for routine radiographic control to less than 10% of patients.

The Accuracy of Electrocardiogram-Controlled Central Line Placement

“…Consequently, a limitation of ECG guidance is the fact that it cannot be reliably used in patients with atrial fibrillation or other supraventricular arrhythmias. Koscielniak-Nielsen et al (7) reported a rate of 96% of satisfactory and good quality ECGs in a study that used both available techniques, ECG conduction via a saline column and via a guidewire. However, guidewire-conducted ECGs were of significantly better quality than those using the saline column.…”

“…In addition, guidelines for CVC positioning issued by the United States Food and Drug Administration and other experts, emphasize that CVCs should not be placed into the right atrium (RA) in order to avoid the potential for cardiac complications (3,4). Previous studies have indicated the usefulness of electrocardiogram (ECG)-guided positioning (RA ECG) for CVC placement (5,6) and the routine use of CXRs to verify CVC position has been questioned (7). However, these studies were either not controlled or only included relatively small sample sizes.…”

Experience of anesthesiologists with percutaneous nonangiographic venous access

“…We routinely use ECG to confirm final catheter position [3][4][5][6]. Depending on the choice of the operator, some patients had a sterile electrode lead (right atrial ECG lead) attached to the guidewire.…”

Extravasale Lage von zentralen Venenkathetern bei korrekter EKG-Ableitung

“…Intra-1: Ausgangs-EKG intravasal, Intra-2: Deutlicher Anstieg der P-Welle, Intra-3: Maximale P-Wellen-Amplitude, Extra-1: V. brachiocephalica links, extravasal oberhalb der perikardialen Umschlagfalte, Extra-2: V. cava superior extravasal unterhalb der perikardialen Umschlagfalte, Extra-A: Aorta ascendens extravasal unterhalb der perikardialen Umschlagfalte. [10,11,19,20].…”