Format

Send to

Choose Destination
J Emerg Trauma Shock. 2018 Oct-Dec;11(4):276-281. doi: 10.4103/JETS.JETS_122_17.

Electrocardiogram-guided Technique: An Alternative Method for Confirming Central Venous Catheter Tip Placement.

Author information

1
Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India.
2
Department of Emergency Medicine, Temple University Hospital, Philadelphia PA, U.S.A.
3
Department of Public Health Dentistry, Amrita School of Dentistry, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, India.

Abstract

Background:

The current standard followed for assessing central venous catheter (CVC) tip placement location is through radiological confirmation using chest X-ray (CXR). Placement of CVCs under electrocardiogram (ECG) guidance may save cost and time compared to CXR.

Objective:

The objective of this study is to compare the accurate placement of the CVC tip using anatomical landmark technique with ECG-guided technique. Another objective is to compare CVC placement time and postprocedural complications between the two techniques.

Methods and Materials:

A total of 144 adult individuals, who were critically ill and required CVC placement in the Emergency Department, were included for the study. Study duration was 6 months. Anatomical landmark and ECG-guided groups were assigned 72 participants each. Analyses were performed using t and Chi square-tests.

Results:

It was observed that 13 (18%) in the landmark technique were malpositioned as compared to none in the ECG-guided technique (P = 0.000). The landmark group had 22 (30.6%) participants with arrhythmias during the procedure, compared to none in the ECG-guided group (P = 0.000). The landmark group revealed that 30 (41.7%) of the CVC were overinserted and required immediate repositioning, compared to none in the ECG-guided group (P = 0.000).

Conclusion:

ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. Furthermore, the ECG-guided technique was more time-effective and had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe and can be considered as an alternative method to conventional radiography for confirmation of CVC tip placement.

KEYWORDS:

Anatomical landmarks; catheter tip; central venous catheter; electrocardiogram-guided

Supplemental Content

Full text links

Icon for Medknow Publications and Media Pvt Ltd Icon for PubMed Central
Loading ...
Support Center