TY - JOUR
T1 - The accuracy of electrocardiogram-controlled central line placement
AU - Gebhard, Ralf E.
AU - Szmuk, Peter
AU - Pivalizza, Evan G.
AU - Melnikov, Vladimir
AU - Vogt, Christianne
AU - Warters, Robert D.
PY - 2007/1
Y1 - 2007/1
N2 - BACKGROUND: Electrocardiogram (ECG) guidance to confirm accurate positioning of central venous catheters (CVC), placed before surgery in the operating room, is rarely used in the United States. We designed this randomized, controlled trial to investigate whether the use of this technique impacts the accuracy of CVC placement. METHODS: Patients in group ECG (n = 147) had a CVC placed using right-atrial ECG to guide catheter tip positioning. CVCs in group NO-ECG (n = 143) were positioned without this technique. RESULTS: Overall, guidewire-ECG control resulted in more correctly positioned CVCs (96% vs 76%, P ≤ 0.001) without increasing placement time. Significantly more CVCs were placed in the middle of the superior vena cava in group ECG (P ≤ 0.001), although placement into the right atrium or right ventricle and into other vessels occurred significantly more often in group NO-ECG (P ≤ 0.001). Twenty patients in group NO-ECG required repositioning of their CVC after surgery, whereas this maneuver was necessary only in three patients in group ECG (P ≤ 0.001). CONCLUSIONS: ECG guidance allows for more accurate CVC placement, and should be considered to increase patient safety and reduce costs associated with repositioning procedures.
AB - BACKGROUND: Electrocardiogram (ECG) guidance to confirm accurate positioning of central venous catheters (CVC), placed before surgery in the operating room, is rarely used in the United States. We designed this randomized, controlled trial to investigate whether the use of this technique impacts the accuracy of CVC placement. METHODS: Patients in group ECG (n = 147) had a CVC placed using right-atrial ECG to guide catheter tip positioning. CVCs in group NO-ECG (n = 143) were positioned without this technique. RESULTS: Overall, guidewire-ECG control resulted in more correctly positioned CVCs (96% vs 76%, P ≤ 0.001) without increasing placement time. Significantly more CVCs were placed in the middle of the superior vena cava in group ECG (P ≤ 0.001), although placement into the right atrium or right ventricle and into other vessels occurred significantly more often in group NO-ECG (P ≤ 0.001). Twenty patients in group NO-ECG required repositioning of their CVC after surgery, whereas this maneuver was necessary only in three patients in group ECG (P ≤ 0.001). CONCLUSIONS: ECG guidance allows for more accurate CVC placement, and should be considered to increase patient safety and reduce costs associated with repositioning procedures.
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U2 - 10.1213/01.ane.0000250224.02440.fe
DO - 10.1213/01.ane.0000250224.02440.fe
M3 - Article
C2 - 17179244
AN - SCOPUS:33847620165
SN - 0003-2999
VL - 104
SP - 65
EP - 70
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 1
ER -