ECG method for confirming central venous catheter tip placement

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The objective of this study is to compare the accurate placement of the CVC tip using anatomical landmark technique with ECG-guided technique” Krishnan et al (2018).

Abstract:

BACKGROUND: The current standard followed for assessing central venous catheter (CVC) tip placement location is through radiological confirmation using chest X-ray (CXR). Placement of CVCs under electrocardiogram (ECG) guidance may save cost and time compared to CXR.

OBJECTIVE: The objective of this study is to compare the accurate placement of the CVC tip using anatomical landmark technique with ECG-guided technique. Another objective is to compare CVC placement time and postprocedural complications between the two techniques.

METHODS AND MATERIALS: A total of 144 adult individuals, who were critically ill and required CVC placement in the Emergency Department, were included for the study. Study duration was 6 months. Anatomical landmark and ECG-guided groups were assigned 72 participants each. Analyses were performed using t and Chi square-tests.

RESULTS: It was observed that 13 (18%) in the landmark technique were malpositioned as compared to none in the ECG-guided technique (P = 0.000). The landmark group had 22 (30.6%) participants with arrhythmias during the procedure, compared to none in the ECG-guided group (P = 0.000). The landmark group revealed that 30 (41.7%) of the CVC were overinserted and required immediate repositioning, compared to none in the ECG-guided group (P = 0.000).

CONCLUSION: ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. Furthermore, the ECG-guided technique was more time-effective and had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe and can be considered as an alternative method to conventional radiography for confirmation of CVC tip placement.

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Reference:
Krishnan, A.K., Menon, P., Gireesh Kumar, K.P., Sreekrishnan, T.P., Garg, M. and Kumar, S.V. (2018) Electrocardiogram-guided Technique: An Alternative Method for Confirming Central Venous Catheter Tip Placement. Journal of Emergencies, Trauma, and Shock. 11(4), p.276-281.

doi: 10.4103/JETS.JETS_122_17.

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