Optimal positioning of right-sided internal jugular venous catheters: comparison of intra-atrial electrocardiography versus Peres' formula

Anish M Joshi, Guruprasad P Bhosale, Geeta P Parikh, Veena R Shah, Anish M Joshi, Guruprasad P Bhosale, Geeta P Parikh, Veena R Shah

Abstract

Central venous catheters are routinely placed in patients undergoing major surgeries where expected volume and hemodynamic disturbances are likely consequences. The incorrect positioning may give false central venous pressure (CVP) readings leading to incorrect volume replacement and other serious complications. 50 American Society of Anaesthesiologists grade II-IV patients aged 18-60 years were selected for right-sided internal jugular vein (IJV) catheterization using Seldinger's technique. In group A, central venous catheterization was done under electrocardiography (ECG) guidance. In group B, the catheter was inserted blindly using Peres' formula of "height (in cm)/10". The position of the tip of central venous catheter was confirmed radiologically by postoperative chest X-ray. 92% of patients in group A had radiologically correct positioning of catheter tip i.e. above the carina, while in group B 48% patients had over-insertion of the catheter in to the right atrium. Intra-atrial ECG technique to judge correct tip positioning is simple and economical. It can determine the exact position intraoperatively and can justify a delayed postoperative chest X-ray to confirm CVC line tip placement.

Keywords: Central venous catheterization; Peres' height formula; intra-atrial electrocardiography.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Modified bipolar lead II being recorded by universal adapter (A) Actual
Figure 1
Figure 1
Modified bipolar lead II being recorded by universal adapter (B) Diagrammatic
Figure 2
Figure 2
(A) Intraatrial ECG in lead II where P wave is larger than R wave
Figure 2
Figure 2
(B) Intraatrial ECG in lead II showing a normal P wave

References

    1. Defalque RJ, Campbell C. Cardiac tamponade from central venous catheters. Anesthesiology. 1979;50:249–52.
    1. Schuster M, Nave H, Piepenbrock S. The carina as a radiological landmark in central venous catheter placement. Br J Anaesth. 2000;85:192–4.
    1. Stonelake PA, Bodenham AR. The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth. 2006;96:335–40.
    1. Czepizak CA, O'Callaghan JM, Venus B. Evaluation of formulas for optimal positioning of central venous catheters. Chest. 1995;107:1662–4.
    1. Chalkiadis GA, Goucke CR. Depth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position. Anesth Intensive Care. 1998;26:61–6.
    1. Wilson RG, Gaer JA. Right atrial electrocardiography in placement of central venous catheters. Lancet. 1988;27:462–3.
    1. Jeon Y, Ryu HG, Yoon SZ, Kim JH, Bahk JH. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anesth. 2006;53:978–83.
    1. Andropoulos DB, Stayer SA, Bent ST, Campos CJ, Alvarez M, Fraser CD. A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients. Anesth Analg. 1999;89:65–70.
    1. Peres PW. Positioning central venous catheters: A prospective survey. Anesth Intensive Care. 1990;18:536–9.
    1. Hellerstein HK, Pritchard WH, Lewis RL. Recording of intracavity potentials through a single lumen, saline filled cardiac catheter. Proc Soc Exp Med. 1949;71:58–60.
    1. Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: Where should the tip of the catheter lie? Br J Anaesth. 2000;85:188–91.
    1. Rutherford JS, Merry AF, Occleshaw CJ. Depth of central venous catheterization: An audit of practice in a cardiac surgical unit. Anaesth Intensive Care. 1994;22:267–71.
    1. Sundaram R, Koteeswaran SK, Smart NG, Stonelake P, Bodenham A. Safe placement of central venous catheters. Br J Anaesth. 2006;97:584–5.
    1. Albrecht K, Nave H, Breitmeier D, Panning B, Tröger HD. Applied anatomy of the superior vena cava-the carina as a radiological landmark to guide central venous catheter placement. Br J Anaesth. 2004;92:75–7.
    1. Yoon SZ, Shin JH, Hahn S. Usefullness of the carina as a radiological landmark for central vanous catheter placement in paediatric patients. Br J Anaesth. 2005;95:514–7.
    1. Caruso LJ, Gravenstein N, Layon AJ. A better landmark for positioning a central vanous catheter. J Clin Monit Comput. 2002;17:331–4.
    1. Watters VA, Grant JP. Use of electrocardiogram to position right atrial catheters during surgery. Ann Surg. 1997;225:165–71.
    1. Francis KR, Picard DL, Fajardo MA, Pizzi WF. Avoiding complications and decreasing costs of central venous catheter placement electrocardiographic guidance. Surg Gynecol Obstet. 1992;175:208–11.
    1. Gebhard RE, Szmuk P, Pivalizza EG. The Accuracy of electrocardiogram controlled central line placement Anesth Analg. 2007;104:65–70.
    1. Schummer W, Herrmann S, Schummer C. Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters. Br J Anaesth. 2003;91:481–6.

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