title: Central venous catheter placement using the ECG-guided Cavafix-Certodyn SD catheter.
abstract: OBJECTIVE
  To evaluate the clinical use of a new ECG-guided central venous catheter with regard to positioning in the superior vena cava (SVC).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Operating rooms of a university hospital and a general hospital.
  
  
  METHODS
  89 elective and emergency adult surgical patients requiring central venous catheterization perioperatively.
  
  
  METHODS
  We performed ECG-guided placement of the central venous catheter from several insertion sites. After we observed an intra-atrial p-wave (p-atriale), the catheter was withdrawn 3 cm back into the SVC. Postoperative anterior-posterior chest radiographs were performed for verification of tip localization.
  
  
  RESULTS
  In all 81 patients who exhibited a p-atriale that reverted to a normal-size p-wave (p-SVC) after withdrawal of the catheter 3 cm, the tip was located in the SVC or the SVC-right atrial junction on the chest radiograph. In 7 of the 8 cases without a p-atriale, the catheter tip was shown to be located at an incorrect position on the chest radiograph. The size of the p-atriale was always at least twice that of the p-SVC.
  
  
  CONCLUSIONS
  Use of this wire-conducted intravascular ECG signal is a reliable tool for positioning the central venous catheter via various insertion sites. The technique proved to be an inexpensive, easy, and clear method. When a p-atriale is seen, uncomplicated insertions do not require radiologic guidance to control catheter tip position.
authors.affiliation: Department of Anesthesiology, Free University Hospital, Amsterdam, Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Corsten
authors.forename: B
authors.initials: B
authors.lastname: van Dijk
authors.forename: N C
authors.initials: NC
authors.lastname: Bakker
authors.forename: J J
authors.initials: JJ
authors.lastname: de Lange
authors.forename: G J
authors.initials: GJ
authors.lastname: Scheffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D004630:Emergencies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013902:Radiography, Thoracic; D015642:Radiology, Interventional; D013350:Subclavian Vein; D014683:Vena Cava, Superior