title: A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients.
abstract: Transesophageal echocardiography (TEE) and central venous catheter (CVC) placement are often used during congenital cardiac surgery. Complications of CVC placement include cardiac perforation, inadvertent arterial placement, and erroneous hemodynamic data from unrecognized malposition. In this study, we used a prospective, randomized, controlled design to evaluate the use of TEE to guide depth of insertion and confirm superior vena cava cannulation, and to improve the percentage of correctly placed CVCs and reduce complications of CVC placement. One hundred forty-five patients were studied. Eighty patients were randomized to have subclavian vein insertion, 64 to have internal jugular insertion, and 1 to have external jugular insertion of CVC. TEE-guided CVC placement resulted in 100% correct placement when assessed by preoperative TEE, versus 86% in the control group (72 of 72 vs. 63 of 73; P = 0.01). There was no difference in correct placement between the two groups when assessed by postoperative chest radiograph (81.9% TEE versus 75.3% control; P = not significant). One significant complication, a superior vena cava perforation, occurred in the control group. Time to placement was 9.6 min in the TEE group versus 8.0 min in the control group (P = 0.015).
  
  
  CONCLUSIONS
  Transesophageal echocardiography can be used to guide central venous catheter placement in congenital heart surgery. Central venous catheters that seem to be located high in the right atrium by chest radiograph in these patients are often actually in the superior vena cava and pose little risk of cardiac perforation.
authors.affiliation: Division of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston 77030-2399, USA. dra@bcm.tmc.edu
authors.forename: D B
authors.initials: DB
authors.lastname: Andropoulos
authors.forename: S A
authors.initials: SA
authors.lastname: Stayer
authors.forename: S T
authors.initials: ST
authors.lastname: Bent
authors.forename: C J
authors.initials: CJ
authors.lastname: Campos
authors.forename: L I
authors.initials: LI
authors.lastname: Bezold
authors.forename: M
authors.initials: M
authors.lastname: Alvarez
authors.forename: C D
authors.initials: CD
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D013902:Radiography, Thoracic