Abstract
Purpose
To facilitate electrocardiography (ECG)-guided central venous catheter placement by observing the shape and size of the P wave at specific locations of a central venous catheter (CVC)tip.
Methods
We evaluated 54 patients for whom central venous catheterization was planned as part of routine care for their elective surgery. The junction of the superior vena cava (SVC) and the right atrium (RA) was defined as the superior border of the crista terminalis by transesophageal echocardiography. The RA ECGs were recorded while withdrawing the CVC into the SVC or advancing it into the RA at 1 -cm intervals. Saline was used as an electrical conductor via the distal lumen of the CVC.
Results
The tallest peaked and biphasic P waves [median (interquartile range)] were observed when the CVC tip was located at positions 0.0 cm (-1.0 to 0.0) and -4.0 cm (-5.0 to-3.0) below the SVC/RA junction, respectively. The P wave returned to a normal shape and size at 4.0 cm (3.0 to 4.0) above the SVC/RA junction. Overshoot P waves were observed at — 4.0 cm (-5.0 to -3.0) below the SVC/RA junction in 22 patients, when the CVC tip appeared to be contacting or in close proximity to the RA wall.
Conclusions
During ECG-guided central venous catheterization, the tallest peaked P wave may be used to place the CVC tip at the SVC/RA junction, the normally-shaped P wave identifies the mid to upper SVC, and biphasic P waves identify RA localization.
Résumé
Objectif
Faciliter la pose d’un cathéter veineux central (CVC) guidée par électrocardiographie (ECG), observant la forme et la taille de l’onde P à des sites spécifiques de la pointe du cathéter.
Méthode
Nous avons évalué 54 patients après insertion d’un cathéter veineux central, partie des soins courants de l’intervention chirurgicale réglée. La jonction de la veine cave supérieure (VCS) et de l’oreillette droite (OD), définie par échocardiographie transœsophagienne, correspondait au bord supérieur de la crête terminale. Les ECG de l’OD ont été enregistrées lors du retrait du CVC de la VCS ou quand il a été poussé dans l’OD à intervalles de 1 cm. Une solution salée a servi de conducteur électrique passant par la lumière distale du CVC.
Résultats
Les ondes P maximales et biphasiques [médiane (écart interquartile)] ont été observées quand la pointe du CVC était respectivement à 0,0 cm (-1,0 à 0,0) et à -4,0 cm (-5,0 à -3,0) sous la jonction VCS/OD. L’onde P a repris une forme et une taille normales à 4,0 cm (3,0 à 4,0) au-dessus de la jonction SVC/OD. Le dépassement des ondes P a été observé à -4,0 cm (-5,0 à -3,0) sous la jonction VCS/OD chez 22 patients au moment où la pointe du CVC paraissait en contact avec la paroi de l’OD ou très près d’elle.
Conclusion
Pendant le cathétérisme veineux central guidé par ECG, l’onde P maximale peut servir à placer la pointe d’un cathéter veineux central à la jonction VCS/OD, l’onde P de forme normale indique la VCS, de son milieu à sa partie supérieure, et l’onde P biphasique situe l’OD.
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This work was supported solely from S.N.U. Foundation & Overhead Research Fund (800-20010243) and performed at Seoul National University Hospital.
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Jeon, Y., Ryu, HG., Yoon, SZ. et al. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anesth 53, 978–983 (2006). https://doi.org/10.1007/BF03022525
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DOI: https://doi.org/10.1007/BF03022525