Optimum depth of central venous catheter - Comparision by pere′s, landmark and endocavitory (atrial) ECG technique: A prospective study

Abstract

Context:Blind insertion of central venous catheter has many implications. Better options should be sought to perform this procedure.Aim:To evaluate various options for positioning central venous catheter tip.Settings and Design:This is institutional based randomized prospective controlled study.Materials and Methods:In this prospective study depth and position of central venous catheter were evaluated in 150 patients in intensive care unit. Three different methods: Pere's, landmark, and endocavitory (atrial) ECG control were used.Statistical Analysis:Twoway ANOVA test was applied on SPSS version 16 to test the significant difference between the three groups.Results:Patient characteristic and demographic data were similar in the three groups. The average depth of central venous catheter by Pere's, landmark, and endocavitory (ECG) technique were 14.20 ± 0.69 cm, 12.08 ± 0.98 cm, and 8.18 ± 0.74 cm, respectively.Conclusion:The correct position of central venous catheter by endocavitory (atrial) ECG appears not only to reduce the procedure related complications but also post procedure manipulation of catheter tip detected by post procedure chest X-ray.

Coiling of central venous catheter: A rare and preventable complication

“…It should be modified into right atrial ECG using wire provided with the CVC set [ Figure 3 ] and an adapter, as it does not increase the financial burden and is more accurate in securing correct position within the SVC even when used as a bedside tool. [ 11 ] CXR radiograph remains the gold standard to confirm the tip of catheter. [ 12 ]…”

Electrocardiogram-guided technique: An alternative method for confirming central venous catheter tip placement

“…CVC tip malpositioning as observed by various authors range from 1.8% to as high as 9.3%. [3] There are multiple studies to support the evidence of ECG guidance for accurate placement of the CVC tip. Ender et al .…”

“…Sample size was calculated using the difference in average depth of CVC between the two methods as obtained from a previous study. [3] Thus, the minimum sample required in each group was found to be five with a 95% confidence and 90% power. More than 70 participants under each group were included in this study.…”

“…CVC placement is a resource intensive procedure with potential for serious complications, such as perforation, tamponade, catheter malpositioning, thrombosis with secondary dysrhythmias, wire-associated adverse events, and infections. [12345678] The optimal position of the CVC tip is at the lower third of the superior vena cava (SVC). [19]…”

“…Thus, ECG-guided CVC placement could be advantageous compared to CXR when considering its high success rate for accurate catheter tip positioning in addition to benefits of safety, time, and cost. [1310]…”