title: Comparison of the bedside central venous catheter placement techniques: landmark vs electrocardiogram guidance.
abstract: BACKGROUND
  Electrocardiogram (ECG)-guided central venous catheter (CVC) placement has been reported to be accurate and successful. It has been shown that the CVC tip can be reliably placed at the level of the carina using a simple formula based on the puncture site, the 'brachiocephalic notch' on the clavicle, and the carina as landmarks. This study was performed to compare the accuracy of CVC tip localization between ECG- and landmark-guided catheterization.
  
  
  METHODS
  Patients were randomized either to the ECG (n=121) or to the landmark (n=128) group. All catheterizations were performed via the right internal jugular vein (IJV). In the ECG group, CVCs were placed where P-wave returned to a normal configuration on right atrial ECG. In the landmark group, CVCs were placed at a depth derived by adding the distance between insertion point and the notch on the clavicle and the vertical length between the notch and the carina on a routine chest radiograph. On the postoperative portable chest radiograph, incidences of correct CVC tip position, defined as in the superior vena cava, were checked.
  
  
  RESULTS
  CVCs were correctly placed in 96.1% of the landmark group (123/128) and in 95.9% of the ECG group (116/121). The mean CVC tip position relative to the carina was 0.0 [95% confidence interval (CI) -0.28 to 0.19] cm in the landmark group and 0.0 (95% CI -0.19 to 0.28) cm in the ECG group.
  
  
  CONCLUSIONS
  During central venous catheterization via the right IJV, landmark guidance was comparable with ECG guidance with regard to CVC tip positioning in the superior vena cava.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Bahk
authors.forename: H-G
authors.initials: HG
authors.lastname: Ryu
authors.forename: C-W
authors.initials: CW
authors.lastname: Jung
authors.forename: Y
authors.initials: Y
authors.lastname: Jeon