title: Accurate placement of central venous catheters in pediatric patients using endocavitary electrocardiography: reassessment of a personal technique.
abstract: To avoid the need for radiological control in the assessment of the proper location of central venous catheters (CVC), a particular use of endocavitary electrocardiography (EC-ECG) was proposed 10 years ago. The aim of this study is to reassess our experience with this method. EC-ECG assumes that the CVC, when filled with normosaline and connected to a standard electrocardiograph, behaves like an exploring electrode. The approach of the catheter tip to the right atrium is then detected by a slightly increasing negative P wave. When the tip reaches the exact level of the sinus node, the P wave suddenly deepens. After a preliminary test of the reliability of the technique versus the standard method in 50 CVC placements verified by both EC-ECG and chest x-ray, we have placed 807 CVCs in children using EC-ECG only. There have been no false-positive and one false-negative test result (lead connector misplacement). In 17 cases in which intrinsic deflection was not detected, the catheter tip was found to be wrongly positioned; all the remainder CVCs have been successfully positioned. For 10 years this technique has proved to be a simple, safe, quick, inexpensive and highly reliable method to assess the correct positioning of the CVC.
authors.affiliation: Clinica di Chirurgia Pediatrica, Universita degli Studi and IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Parigi
authors.forename: G
authors.initials: G
authors.lastname: Verga
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies