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J Vasc Access. 2018 Dec 31:1129729818819422. doi: 10.1177/1129729818819422. [Epub ahead of print]

A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients.

Author information

1
1 Department of Cardiovascular Surgery, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy.
2
2 Department of Intensive Care and Anesthesia, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy.
3
3 Department of Surgery, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy.

Abstract

INTRODUCTION::

The intracavitary electrocardiographic method is recommended for assessing the location of the tip of central venous catheter when there is an identifiable P wave. Previous reports suggested that intracavitary electrocardiographic method might also be applied to patients with atrial fibrillation, considering the so-called f waves as a surrogate of the P wave.

METHODS::

We studied 18 atrial fibrillation patients requiring simultaneously a central venous catheter and a trans-esophageal echocardiography. An intracavitary electrocardiographic trace was recorded with the catheter tip in three different positions defined by trans-esophageal echocardiography imaging: in the superior vena cava, 2 cm above the cavo-atrial junction; at the cavo-atrial junction; and in the right atrium, 2 cm below the cavo-atrial junction. Three different criteria of measurement of the f wave pattern in the TQ tract were used: the mean height of f waves (method A); the height of the highest f wave (method B); the difference between the highest positive peak and the lowest negative peak (method C).

RESULTS::

There were no complications. With the tip placed at the cavo-atrial junction, the mean value of the f waves was significantly higher than in the other two positions. All three methods were effective in discriminating the tip position at the cavo-atrial junction, though method B proved to be the most accurate.

CONCLUSION::

A modified intracavitary electrocardiographic technique can be safely used for detecting the location of the tip of central venous catheters in atrial fibrillation patients: the highest activity of the f waves is an accurate indicator of the location of the tip at the cavo-atrial junction.

KEYWORDS:

Atrial fibrillation; cavo-atrial junction; central venous catheter; intracavitary electrocardiographic method; tip location; trans-esophageal echocardiography

PMID:
30596473
DOI:
10.1177/1129729818819422

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