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

Deepak Sharma, V P Singh, M K Malhotra, Kumkum Gupta, Deepak Sharma, V P Singh, M K Malhotra, Kumkum Gupta

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.

Keywords: Central venous catheter; ECG guided endocavitory; landmark; pere's; subclavian vein; superior vena cava.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Depicting improvised adaptor with established connection between the monitor and guidewire mounted central venous catheter
Figure 2
Figure 2
(a) Normal endocavitory (atrial) ECG. (b) ‘P’ wave increase in amplitude progressively to reach maximum (denoting location of SA node). (c) normal configuration is reverted on catheter retrieve
Figure 3
Figure 3
Postinsertion chest X-ray displaying normal position of CVC tip (arrow) in relation to carina

References

    1. Caruso LJ, Gravestein N, Layon A, Peters K, Gabrielli A. A better landmark for positioning central venous catheter. J Clin Monit Comput. 2002;17:331–4.
    1. Joffe HV, Goldhaber SZ. Upper-Extremity Deep Vein Thrombosis. Circulation. 2002;106:1874–80.
    1. Tilak MD, Proctor SM, Donovan JF, Jr, Fitch JC. Extravascular placement of a central venous catheter in the mediastinum. J Cardiothorac Vasc Anesth. 2004;18:75–7.
    1. Schuster M, Nave H, Piepenbrock S, Pabst R, Panning B. The carina as a landmark in central venous catheter placement. Br J Anaesth. 2000;85:192–4.
    1. McGee WT, Ackermann BL, Rouben LR, Prasad VM, Bandi V, Mallory DL. Accurate placement of central venous catheter: A prospective, randomized, multicenter trial. Crit Care Med. 1993;21:1118–23.
    1. Tocino IM, Watanabe A. Impending catheter perforation of superior vena cava: Radiographic recognition. AJR Am J Roengenol. 1986;146:487–90.
    1. Dalley RH. Late vascular perforation by CVP catheter tips. J Emerg Med. 1988;6:137–40.
    1. Peres PW. Positioning Central Venous Catheters- a prospective survey. Anaesth Intensive Care. 1990;18:536–39.
    1. Andropoulos DB, Bent ST, Skjonsby B, Stayer SA. The Optimal Length of Insertion of Central Venous Catheter for Pediatric Patients. Anesth Analg. 2001;93:883–86.
    1. Ryu HG, Bahk JH, Kim JT, Lee JH. Bed side prediction of central venous catheter insertion depth. Br J Anaesth. 2007;98:225–7.
    1. Kujar R, Roa MS, Mrinal M. How correct is the correct length for central venous catheter insertion. Indian J Crit Care Med. 2009;13:159–62.
    1. Czepizak CA, O’Callaghan JM, Venus B. Evaluation of Formulas for Optimal Positioning of Central Venous Catheters. Chest. 1995;107:1662–4.
    1. Albrecht K, Nave H, Breitmeier D, Panning B, Tröger HD. Applied anatomy of superior vena cava- the carina as a landmark to guide central venous catheter placement. Br J Anaesth. 2004;92:75–7.
    1. Sivasubramaniam S, Hiremath M. Central venous catheters: Do we need to review practice on positioning? JICS. 2008;9:228–31.
    1. McGee WT, Moriarty KP. Accurate Placement of Central Venous Catheters Using a 16-cm Catheter. J Intensive Care Med. 1996;11:19–22.
    1. Russell WC, Parker JL. Thirteen centimetre central venous catheters, lucky for all? Anaesthesia. 2003;58:388.
    1. Lee JH, Bahk JH, Ryu HG, Jung CW, Jeon Y. Comparison of the bedside central venous catheter technique: landmark vs electrocardiogram guidance. Br J Anaesth. 2009;102:662–6.
    1. Iovino F, Pittiruti M, Buononato M, Lo Schiavo F. Central venous catheterization complications of different placements. Ann Chir. 2001;126:1001–6.
    1. Ruesch S, Walder B, Tramer MR. Complications of central venous catheter: Internal jugular versus subclavian access - A systemic review. Critical Care Med. 2002;30:454–60.
    1. Sharma D. Adaptor for endocavitory ECG monitoring. J Anaesth Clin Pharmacol. 2009;25:327–28.
    1. Calabria M, Zamboli P, D’Amelio A, Granata A, Di Lullo L, Floccari F, et al. Use of ECG-EC in the positioning of central venous catheters. G Ital Nefrol. 2012;29:49–57.

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