title: Optimal positioning of right-sided internal jugular venous catheters: comparison of intra-atrial electrocardiography versus Peres' formula.
abstract: Central venous catheters are routinely placed in patients undergoing major surgeries where expected volume and hemodynamic disturbances are likely consequences. The incorrect positioning may give false central venous pressure (CVP) readings leading to incorrect volume replacement and other serious complications. 50 American Society of Anaesthesiologists grade II-IV patients aged 18-60 years were selected for right-sided internal jugular vein (IJV) catheterization using Seldinger's technique. In group A, central venous catheterization was done under electrocardiography (ECG) guidance. In group B, the catheter was inserted blindly using Peres' formula of "height (in cm)/10". The position of the tip of central venous catheter was confirmed radiologically by postoperative chest X-ray. 92% of patients in group A had radiologically correct positioning of catheter tip i.e. above the carina, while in group B 48% patients had over-insertion of the catheter in to the right atrium. Intra-atrial ECG technique to judge correct tip positioning is simple and economical. It can determine the exact position intraoperatively and can justify a delayed postoperative chest X-ray to confirm CVC line tip placement.
authors.affiliation: Department of Anesthesia and Critical Care, GR Doshi and KM Mehta Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences, Civil Hospital campus, Asarwa, Ahmedabad - 380 016, Gujarat, India. dranishjoshi@yahoo.com
authors.forename: Anish M
authors.initials: AM
authors.lastname: Joshi
authors.forename: Guruprasad P
authors.initials: GP
authors.lastname: Bhosale
authors.forename: Geeta P
authors.initials: GP
authors.lastname: Parikh
authors.forename: Veena R
authors.initials: VR
authors.lastname: Shah