| Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance. | |
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MedLine Citation:
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PMID: 21697183 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Central venous catheter (CVC) placement under ECG guidance in the left thoracocervical area can lead to catheter misplacement. The aim of this study was to identify the cause and quantify the magnitude of this error. METHODS: CVCs were sited in either the left or right internal jugular (IJ), subclavian (SC), or innominate (brachiocephalic) vein using the Seldinger technique and a total of 227 insertions were studied. The position of the catheter tip was confirmed with two different intra-atrial ECG monitoring methods (Seldinger's wire vs 10% saline solution). Measurements were compared between the two methods and correlated to the different access sites. RESULTS: All right-sided CVC had the line tip in the optimal position and both intra-atrial ECG recording by Seldinger's wire or 10% saline delivered correct results. For left-sided lines, however, the two methods gave significantly different results regarding the position of the line tip for each insertion site. When using the Seldinger wire as intravascular ECG lead, the results differed from the saline method by a mean of 21 mm for the IJ and 10 mm for the SC. CONCLUSIONS: CVC placement under ECG guidance is a reliable method to site the line tip at the optimal position. However, when using a left-sided thoracocervical access point, the Seldinger wire-conducted ECG delivered a constant error. This could be adjusted for by advancing the CVC 20 mm in addition to the wire-based measurement of the insertion depth at the left IJ vein and 10 mm at the left SC vein. |
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Authors:
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J Kremser; F Kleemann; K Reinhart; W Schummer |
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Publication Detail:
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Type: Journal Article Date: 2011-06-22 |
Journal Detail:
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Title: British journal of anaesthesia Volume: 107 ISSN: 1471-6771 ISO Abbreviation: Br J Anaesth Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-09 Completed Date: 2011-10-31 Revised Date: 2012-02-21 |
Medline Journal Info:
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Nlm Unique ID: 0372541 Medline TA: Br J Anaesth Country: England |
Other Details:
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Languages: eng Pagination: 567-72 Citation Subset: IM |
Affiliation:
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Department of Anaesthesiology and Intensive Care Medicine, SRH Zentralklinikum Suhl gGmbH, Teaching Hospital of Friedrich Schiller University Jena, Albert-Schweitzer-Straße 2, 98527 Suhl, Germany. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Brachiocephalic Veins Catheterization, Central Venous / methods* Catheters Catheters, Indwelling Electrocardiography / methods* Female Humans Jugular Veins Male Middle Aged Prospective Studies Radiography, Thoracic Respiration, Artificial Subclavian Vein |
| Comments/Corrections | |
Comment In:
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Br J Anaesth. 2012 Feb;108(2):325-6; author reply 826
[PMID:
22250281
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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