title: The accuracy of electrocardiogram-controlled central line placement.
abstract: BACKGROUND
  Electrocardiogram (ECG) guidance to confirm accurate positioning of central venous catheters (CVC), placed before surgery in the operating room, is rarely used in the United States. We designed this randomized, controlled trial to investigate whether the use of this technique impacts the accuracy of CVC placement.
  
  
  METHODS
  Patients in group ECG (n = 147) had a CVC placed using right-atrial ECG to guide catheter tip positioning. CVCs in group NO-ECG (n = 143) were positioned without this technique.
  
  
  RESULTS
  Overall, guidewire-ECG control resulted in more correctly positioned CVCs (96% vs 76%, P < or = 0.001) without increasing placement time. Significantly more CVCs were placed in the middle of the superior vena cava in group ECG (P < or = 0.001), although placement into the right atrium or right ventricle and into other vessels occurred significantly more often in group NO-ECG (P < or = 0.001). Twenty patients in group NO-ECG required repositioning of their CVC after surgery, whereas this maneuver was necessary only in three patients in group ECG (P < or = 0.001).
  
  
  CONCLUSIONS
  ECG guidance allows for more accurate CVC placement, and should be considered to increase patient safety and reduce costs associated with repositioning procedures.
authors.affiliation: Department of Anesthesiology, Ryder Trauma Center T-239, University of Miami-Miller School of Medicine, Miami, Florida 33136-1018, USA. rgebhard@med.miami.edu
authors.forename: Ralf E
authors.initials: RE
authors.lastname: Gebhard
authors.forename: Peter
authors.initials: P
authors.lastname: Szmuk
authors.forename: Evan G
authors.initials: EG
authors.lastname: Pivalizza
authors.forename: Vladimir
authors.initials: V
authors.lastname: Melnikov
authors.forename: Christianne
authors.initials: C
authors.lastname: Vogt
authors.forename: Robert D
authors.initials: RD
authors.lastname: Warters
mesh_terms: D000328:Adult; D001835:Body Weight; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D018579:Patient Selection; D011300:Preoperative Care; D012449:Safety; D012984:Software