Central venous catheter placement in children: evaluation of electrocardiography using J-wire.
Misplacement of a central venous catheter may lead to myocardial perforation and dysrhythmia. Atrial electrocardiography (ECG) through a saline column is an effective but complex method to determine the accurate location of catheters. We evaluated a simplified variant of this technique using the guidewire as an internal electrode in 23 children (5-16 years old) undergoing spinal surgery. Catheters were placed using a Seldinger technique after jugular or subclavian venous puncture. Each time the operator recognized the atrial signal, the catheter was found to be correctly placed on the chest radiograph (20/23). In three patients, the atrial signal was not obtained. A technical error was responsible in one case whereas the two others were related to aberrant migrations of the catheter either into a subclavian vein or into the pleura. In this latter case, the complication was unrecognized on the first radiograph despite malposition having been predicted by atrial ECG. We conclude that a method using atrial ECG guidance is sensitive and specific, and may be an alternative to the classical chest radiograph to detect accurate placement of central venous catheters in children.
Simon
L
L
Service d'anesthésiologie pédiatrique, Hôpital St Vincent de Paul, Paris, France.
Teboul
A
A
Gwinner
N
N
Boulay
G
G
Cerceau-Delaporte
S
S
Hamza
J
J
D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D004562:Electrocardiography / Q000295:instrumentation*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012600:Scoliosis / Q000601:surgery; D013131:Spine / Q000601:surgery*