Determining central venous catheter tip location by electrocardiogram


#IVTEAM #Intravenous literature: Shah, P.N., Kane, D. and Appukutty, J. (2013) Depth of central venous catheterization by intracardiac electrocardiogram in adults. Anesthesiology and Pain Medicine. 2(3), p.111-4.


BACKGROUND: Central venous catheterization is done frequently in cardiac surgery and intensive care settings. Faulty positioning of the catheter can cause many complications.

OBJECTIVES: The aim of our study was to study the average depth of insertion and formulate a general guideline through the right internal jugular vein (IJV).

PATIENTS AND METHODS: The right IJV was cannulated over a period of four months and catheter tip positioning was guided by means of an intracardiac electrocardiogram (ECG). Insertion depth was registered at the position of maximum P wave amplitude and the catheter was fixed after withdrawing 2 cm. Pearson’s correlation coefficient was calculated to categorize any relationship between plots of distance versus patient’s height, and regression lines and equations were also calculated. Bland-Altman analysis of data was done to compare the old formulae with our derived formulae.

RESULTS: A total of 155 adult patients were studied. Distances measured were found to be highly correlated with a patient’s height, followed by body surface area (BSA) and weight. For right IJV cannulation in valvular surgeries in adults, the depth of insertion (cm) was (height in cm / 15) + 2 ± 1.58 (SD) and in non-valvular surgeries in adults, it was (height in cm/15) + 1.4 ± 1.47 (SD). The bias was very small when the new formulae were compared to the existing formulae.

CONCLUSIONS: The devised formulae predicted the required depth of catheters thereby reducing the possibility of complications and need for radiographic confirmation.

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