title: Atrial ECG as a guide to the placement of central venous catheter in patients undergoing Open Heart Surgery.
abstract: Hundred adults undergoing open heart surgery were randomized into two equal groups. In group I (n=50), surface anatomical landmarks and in group II (n=50) atrial ECG was used as a guide for correct placement of the central venous catheter (within 1 cm of superior vena cava - right atrial junction). The position of the catheter tip was confirmed by direct palpation by the surgeon on the operating table and by radiological examination in the post operative period. Surgeon's assessment revealed that the catheter was successfully placed in 32 (69.6%) patients in group II and 25 (50%) patients in group I (p=NS). Radiological examination revealed that the catheter was successfully placed in 31 (67.4%) patients in group II and in 28 (57.1%) patients in group I (p=NS). Amongst the unsuccessful placements right atrial placement was present in 5 patients (10%) in group I and 7 patients (15.2%) in group II by surgeon's assessment and 8 patients (16.3%) in group I and 9 patients (9.6%) in group II by radiological examination (p=NS) No complications related to intracardiac placement occurred in any of the patients. We conclude that atrial ECG is a promising technique for central venous catheter placement, although it did not significantly increase the correct placement in this study. This may be due to alteration in the relationship of sino-atrial node and superior vena cava - right atrial junction in patients with cardiac disease. Further studies defining the correct technique of insertion, (especially in cardiac patients) are necessary to improve the success rate.
authors.affiliation: Department of Anaesthesiology, Cardiothoracic Surgery and Radiology, G.B. Pant Hospital, New Delhi, India. tempedeepak@hotmail.com
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Tempe
authors.forename: Sanjula
authors.initials: S
authors.lastname: Virmani
authors.forename: A S
authors.initials: AS
authors.lastname: Tomar
authors.forename: Vishnu
authors.initials: V
authors.lastname: Datt
authors.forename: Nisheet
authors.initials: N
authors.lastname: Aggarwal
authors.forename: Satyendra
authors.initials: S
authors.lastname: Yadav
authors.forename: Poonam
authors.initials: P
authors.lastname: Narang
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Minhas
authors.forename: Amit
authors.initials: A
authors.lastname: Banerjee