title: Transesophageal echocardiography for verification of the position of the electrocardiographically-placed central venous catheter.
abstract: OBJECTIVE
  Compare changes in P-wave amplitude of the intra-atrial electrocardiogram (ECG) and its corresponding transesophageal echocardiography (TEE)-controlled position to verify the exact localization of a central venous catheter (CVC) tip.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  University, single-institutional setting.
  
  
  METHODS
  Two hundred patients undergoing elective cardiac surgery.
  
  
  METHODS
  CVC placement via the right internal jugular vein with ECG control using the guidewire technique and TEE control in 4 different phases: phase 1: CVC placement with normalized P wave and measurement of distance from the crista terminalis to the CVC tip; phase 2: TEE-controlled placement of the CVC tip; parallel to the superior vena cava (SVC) and measurements of P-wave amplitude; phase 3: influence of head positioning on CVC migration; and phase 4: evaluation of positioning of the CVC postoperatively using a chest x-ray.
  
  
  RESULTS
  The CVC tip could only be visualized in 67 patients on TEE with a normalized P wave. In 198 patients with the CVC parallel to the SVC wall controlled by TEE (phase 2), an elevated P wave was observed. Different head movements led to no significant migration of the CVC (phase 3). On a postoperative chest-x-ray, the CVC position was correct in 87.6% (phase 4).
  
  
  CONCLUSIONS
  The study suggests that the position of the CVC tip is located parallel to the SVC and 1.5 cm above the crista terminalis if the P wave starts to decrease during withdrawal of the catheter. The authors recommend that ECG control as per their study should be routinely used for placement of central venous catheters via the right internal jugular vein.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine II, University of Leipzig, Heart Center, Leipzig, Germany. joerg.ender@medizin.uni-leipzig.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Ender
authors.forename: Gabor
authors.initials: G
authors.lastname: Erdoes
authors.forename: Eugen
authors.initials: E
authors.lastname: Krohmer
authors.forename: Derk
authors.initials: D
authors.lastname: Olthoff
authors.forename: Chirojit
authors.initials: C
authors.lastname: Mukherjee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D055815:Young Adult