title: Endovascular electrocardiography to guide placement of totally implantable central venous catheters in oncologic patients.
abstract: OBJECTIVE
  Appropriate tip position of totally implantable central venous catheters is essential in order to prevent catheter-related complications, in particular thrombosis. Endovascular electrocardiography is an economic and safe method to guide placement of catheters into the central veins. Although widely utilized, there is still lack of conclusive evidence about its efficacy. The aim of the study was to assess the efficacy and safety of endovascular electrocardiographic guided placement compared to the anthropometric method.
  
  
  METHODS
  Endovascular ECG was employed to guide electrocardiographic placement of a central venous catheter in a cohort of oncologic patients. The rate of correct placement and the incidence of catheter-related thrombosis were considered. Patients in which central venous catheters were inserted with the anthropometric technique were considered as control group.
  
  
  RESULTS
  The rate of correct placement was 91% and 50% for ECG-guided and anthropometric catheters (p<0.0001) respectively. None of the patients suffered from early insertion-related complications. The rate of catheter-related vascular thrombosis was lower for ECG-guided catheters (3.6% vs. 9.6%, n.s.), in particular for left-inserted catheters (0% vs. 33.3%, p=0.02).
  
  
  CONCLUSIONS
  Endovascular electrocardiography was more effective than the anthropometric technique in placement of implantable central venous catheters and was associated with a lower incidence of catheter-related thrombosis, in particular for those inserted from the left-side.
authors.affiliation: Department of Critical Care, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pelagatti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Villa
authors.forename: Andrea
authors.initials: A
authors.lastname: Casini
authors.forename: Cosimo
authors.initials: C
authors.lastname: Chelazzi
authors.forename: Angelo Raffaele
authors.initials: AR
authors.lastname: De Gaudio
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004562:Electrocardiography; D057510:Endovascular Procedures; D004867:Equipment Design; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000970:Antineoplastic Agents