title: Avoiding complications and decreasing costs of central venous catheter placement utilizing electrocardiographic guidance.
abstract: A technique for electrocardiographic (ECG) guided percutaneous placement of central venous catheters (CVC) was studied in a prospective, randomized manner. In 34 patients, 51 ECG guided percutaneous CVC were compared with 29 blind percutaneous CVC in 23 patients. Thirty-nine percent of CVC placements were changes over a guide wire. Ideal catheter tip location at the atriocaval junction was achieved in 96 percent of the patients in the study versus 59 percent of those in the control group (p less than 0.001). In addition, we report 25 patients with open placement of CVC using intraoperative ECG guidance and fluoroscopic confirmation. Ideal location of the catheter tip was achieved in 100 percent of these patients. ECG guided CVC placement using the technique described herein obviates the need for catheter repositioning, repeat roentgenographic studies and intraoperative fluoroscopic imaging, along with the attendant costs and radiation exposure to staff and patient. Aberrant catheter tip placement and the associated morbidity are also eliminated.
authors.affiliation: Department of Surgery, Cornell University Medical College, Jamaica, New York.
authors.forename: K R
authors.initials: KR
authors.lastname: Francis
authors.forename: D L
authors.initials: DL
authors.lastname: Picard
authors.forename: M A
authors.initials: MA
authors.lastname: Fajardo
authors.forename: W F
authors.initials: WF
authors.lastname: Pizzi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology; D002405:Catheterization, Central Venous / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004562:Electrocardiography / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008991:Monitoring, Physiologic / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies