Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-19T08:07:36.934Z Has data issue: false hasContentIssue false
  • English
  • Français

Central venous catheter placement: comparison of the intravascular guidewire and the fluid column electrocardiograms

Published online by Cambridge University Press:  23 December 2004

M. T. Pawlik ,
N. Kutz ,
C. Keyl ,
P. Lemberger  and
E. Hansen
M. T. Pawlik
Affiliation:
University of Regensburg, Department of Anaesthesiology, Regensburg, Germany
N. Kutz
Affiliation:
University of Regensburg, Department of Anaesthesiology, Regensburg, Germany
C. Keyl
Affiliation:
University of Regensburg, Department of Anaesthesiology, Regensburg, Germany
P. Lemberger
Affiliation:
University of Regensburg, Department of Anaesthesiology, Regensburg, Germany
E. Hansen
Affiliation:
University of Regensburg, Department of Anaesthesiology, Regensburg, Germany
Get access

Abstract

Summary

Background and objective: Placement of central venous catheters in patients is associated with several risks including endocardial lesions and dysrhythmias. Correct positioning of central venous catheters in the superior vena cava is essential for immediate use. The objective of a first study was to evaluate the signal quality of an intravascular electrocardiogram (ECG) during position control using a guidewire compared with the customary fluid column-based ECG system, and to assess its efficacy of correct placement of the central venous catheter. A second study tested if dysrhythmias can be avoided by intravascular ECG monitoring during catheter and guidewire advancement.

Methods: The jugular or subclavian vein of 40 patients undergoing heart surgery or who were being treated in the intensive care unit was cannulated. Intravascular ECGs were recorded during position control, and guidewire and water column lead were compared in the same patient with regard to the quality of the ECG reading and P-wave enhancement. In another 40 patients, the guidewire was inserted only 10 cm and the central venous catheter advanced under guidewire ECG control. Correct position of all the central venous catheters was confirmed by chest radiography.

Results: All central venous catheters were correctly positioned in the superior vena cava. For the same catheter position, the P-wave was significantly larger in the guidewire ECG than in the fluid column system. No changes in the quality of the ECG were detected when the guidewire was advanced or withdrawn by 1 cm relative to the catheter tip. Cardiac dysrhythmias were not seen during ECG-monitored advancement of the guidewire.

Conclusions: ECG quality using a guidewire lead is superior to the water column-based system. Furthermore, it is independent from the exact position of the guidewire as related to the tip of the catheter. Using intravascular guidewire ECG during advancement can prevent induction of dysrhythmias.

Keywords

CENTRAL VENOUS CATHETERIZATION, adverse effects, methodsDYSRHYTHMIA, preventionELECTROCARDIOGRAM (ECG), intravascular
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 8 , August 2004 , pp. 594 - 599
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Malatinsky J, Kadlic T, Majek M, Samel M. Misplacement and loop formation of central venous catheters. Acta Anaesthesiol Scand 1976; 20: 237–247.Google Scholar
Food and Drug Administration. Precautions necessary with central venous catheters. FDA Drug Bulletin 1989; July: 15–16.
Gilday DL. The value of chest radiography in the localization of central venous pressure catheters. Can Med Assoc J 1969; 101: 363–364.Google Scholar
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.Google Scholar
Donovan KD, Power BM, Hockings BM, Lee KY, Barrowcliffe MB, Lovett M. Usefulness of atrial electrograms recorded via central venous catheters in the diagnosis of complex cardiac arrhythmias. Crit Care Med 1993; 21: 532–537.Google Scholar
Robertson JT, Schick RW, Morgan F, Matson DD. Accurate placement of ventriculo-atrial shunt for hydrocephalus under electrocardiographic control. J Neurosurg 1961; 18: 255–257.Google Scholar
Hughes RE, McGovern GJ. The relationship between right atrial pressure and blood volume. Arch Surg 1959; 79: 238–243.Google Scholar
Koscielniak-Nielsen ZJ, Otkjaer S, Hansen OB, Hemmingsen C. CVP catheter electrocardiography: an alternative to radiographic control after cannulation of central veins? Acta Anaesthesiol Scand 1991; 35: 762–766.Google Scholar
Jamal NM, Hernandez JF, Wyso EM. CVP catheter tip. Location by means of intra-atrial lead. NY State J Med 1974; 74: 2348–2351.Google Scholar
Wilson RG, Gaer JA. Right atrial electrocardiography in placement of central venous catheters. Lancet 1988; i: 462–463.Google Scholar
McGee WT, Ackerman BL, Rouben LR, Prasad VM, Bandi V, Mallory DL. Accurate placement of central venous catheters: a prospective, randomized, multicenter trial. Crit Care Med 1993; 21: 1118–1123.Google Scholar
Marouche A, Engelhardt W, Druge G, Hartung E, Roewer N. ECG control of the position of the central venous catheter using the Seldinger guidewire: clinical and economic aspects. Anaesthesiol Intensivmed Notfallmed Schmerzther 1998; 33: 114–117. [in German]Google Scholar
Corsten SA, Van Dijk B, Bakker NC, de Lange JJ, Scheffer GJ. Central venous catheter placement using the ECG-guided Cavafix–Certodyn SD catheter. J Clin Anesth 1994; 6: 469–472.Google Scholar
Schummer W, Herrmann S, Schummer C, et al. Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters. Br J Anaesth 2003; 91: 481–486.Google Scholar
Michenfelder JD, Martin JT, Altenburg BM, Rehder K. Air embolism during neurosurgery. An evaluation of right-atrial catheters for diagnosis and treatment. JAMA 1969; 208: 1353–1358.Google Scholar
Bowdle TA, Artru AA. Positioning the air aspiration pulmonary artery catheter introducer sheath by intravascular electrocardiography. Anesthesiology 1988; 69: 276–279.Google Scholar
Salmela L, Aromaa U. Verification of the position of a central venous catheter by intra-atrial ECG. When does this method fail? Acta Anaesthesiol Scand 1993; 37: 26–28.Google Scholar
Collier PE, Ryan JJ, Diamond DL. Cardiac tamponade from central venous catheters. Report of a case and review of the English literature. Angiology 1984; 35: 595–600.Google Scholar
Aldridge HE, Jay AW. Central venous catheters and heart perforation. Can Med Assoc J 1986; 135: 1082–1084.Google Scholar
Lumb PD. Complications of central venous catheters. Crit Care Med 1993; 21: 1105–1106.Google Scholar
Engelhardt W, Sold M, Helzel MV. ECG-controlled placement of central venous catheters in patients with atrial fibrillation. Anaesthesist 1989; 38: 476–479. [in German]Google Scholar