title: Accurate central venous port-A catheter placement: intravenous electrocardiography and surface landmark techniques compared by using transesophageal echocardiography.
abstract: Using transesophageal echocardiography (TEE) to locate the tip of central venous catheters inserted via the right subclavian vein, we compared IV electrocardiography (IV-ECG)-guided catheter tip placement with the conventional surface landmark technique. Sixty patients were randomly assigned into two groups. In Group E, the IV-ECG signal was conducted along an NaHCO(3)-filled catheter to facilitate catheter placement. In Group S, surface landmarks on the chest wall were used to determine the appropriate catheter length. The goal was to visualize the catheter tip with TEE at the superior edge of the crista terminalis, which is the junction of the superior vena cava (SVC) and right atrium (RA). The catheter tip position was considered to be satisfactory, as the tip was within 1.0 cm of the upper crista terminalis edge. All 30 Group E patients had satisfactory catheter tip placement when the ECG P wave was at its maximum. In contrast, 16 of the 30 patients in Group S had satisfactory tip positions (P < 0.001). All catheters were repositioned under TEE guidance to adjust the tip to the SVC-RA junction. After the catheter tips were confirmed to be located at the SVC-RA junction, the catheter tips were still visualized in the mid portion of RA in 12 of 60 patients on supine chest radiographs. We concluded that IV-ECG guidance to position a catheter resulted in satisfactory catheter tip placement that is in accordance with TEE views. Catheter placement at the SVC-RA junction with the surface landmark technique was unreliable.
  
  
  CONCLUSIONS
  Intravenous electrocardiography guidance to position catheters obtains a satisfactory catheter tip placement that is in accordance with transesophageal echocardiography views. The surface landmark technique does not result in reliable placement at the superior vena cava-right atrium junction.
authors.affiliation: *Department of Anesthesiology, Kuo General Hospital, Tainan, Taiwan; and Departments of †Pediatrics, ‡Surgery, §Anesthesiology, and Medical Imaging, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Koung-Shing
authors.initials: KS
authors.lastname: Chu
authors.forename: Jong-Hau
authors.initials: JH
authors.lastname: Hsu
authors.forename: Shie-Shan
authors.initials: SS
authors.lastname: Wang
authors.forename: Chao-Shun
authors.initials: CS
authors.lastname: Tang
authors.forename: Kuang-I
authors.initials: KI
authors.lastname: Cheng
authors.forename: Chien-Kuo
authors.initials: CK
authors.lastname: Wang
authors.forename: Jiunn-Ren
authors.initials: JR
authors.lastname: Wu
mesh_terms: D000368:Aged; D000758:Anesthesia; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D011859:Radiography; D013350:Subclavian Vein / Q000033:anatomy & histology / Q000000981:diagnostic imaging