Transesophageal echocardiography for verification of the position of the electrocardiographically-placed central venous catheter

Ender, Joerg; Erdoes, Gabor; Krohmer, Eugen; Olthoff, Derk; Mukherjee, Chirojit (2009). Transesophageal echocardiography for verification of the position of the electrocardiographically-placed central venous catheter. Journal of cardiothoracic and vascular anesthesia, 23(4), pp. 457-61. New York, N.Y.: Elsevier 10.1053/j.jvca.2008.12.003

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OBJECTIVE: Compare changes in P-wave amplitude of the intra-atrial electrocardiogram (ECG) and its corresponding transesophageal echocardiography (TEE)-controlled position to verify the exact localization of a central venous catheter (CVC) tip. DESIGN: A prospective study. SETTING: University, single-institutional setting. PARTICIPANTS: Two hundred patients undergoing elective cardiac surgery. INTERVENTIONS: CVC placement via the right internal jugular vein with ECG control using the guidewire technique and TEE control in 4 different phases: phase 1: CVC placement with normalized P wave and measurement of distance from the crista terminalis to the CVC tip; phase 2: TEE-controlled placement of the CVC tip; parallel to the superior vena cava (SVC) and measurements of P-wave amplitude; phase 3: influence of head positioning on CVC migration; and phase 4: evaluation of positioning of the CVC postoperatively using a chest x-ray. MEASUREMENTS AND MAIN RESULTS: The CVC tip could only be visualized in 67 patients on TEE with a normalized P wave. In 198 patients with the CVC parallel to the SVC wall controlled by TEE (phase 2), an elevated P wave was observed. Different head movements led to no significant migration of the CVC (phase 3). On a postoperative chest-x-ray, the CVC position was correct in 87.6% (phase 4). CONCLUSION: The study suggests that the position of the CVC tip is located parallel to the SVC and 1.5 cm above the crista terminalis if the P wave starts to decrease during withdrawal of the catheter. The authors recommend that ECG control as per their study should be routinely used for placement of central venous catheters via the right internal jugular vein.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
UniBE Contributor:	Erdoes, Gabor (A)
ISSN:	1053-0770
Publisher:	Elsevier
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 15:11
Last Modified:	29 Mar 2023 23:33
Publisher DOI:	10.1053/j.jvca.2008.12.003
PubMed ID:	19217801
Web of Science ID:	000269332500003
URI:	https://boris.unibe.ch/id/eprint/31334 (FactScience: 195806)