title: Intravenous electrocardiography helps inexperienced operators to place totally implantable venous access device more accurately.
abstract: BACKGROUND
  Proper tip position is a major determinant of totally implantable venous access device (TIVAD) outcome. The aim of this study is to analyze the potential utilization of intravenous electrocardiography (IV-ECG) to help inexperienced operators for TIVAD placement.
  
  
  METHODS
  This is a retrospective, observational, uni-institutional study. 331 patients receiving TIVAD implantation from July 2008 to December 2008 were recruited. In IV-ECG group, IV-ECG was used to help decide catheter tip location and catheter length. In Landmark group, catheter length was decided by surface landmarks. Catheter tip position was confirmed by post-operative supine chest X-ray.
  
  
  RESULTS
  There were 153 patients in IV-ECG group, and 178 patients in Landmark group. No immediate reoperation due to catheter mal-position was noted in IV-ECG group, but it happened in eight patients in Landmark group. In IV-ECG group, 97.3% of the catheter tip located at proper position (within 2 cm from junction of right atrium and superior vena cava, as compared to 88.8% of the tip position in Landmark group was proper. The difference was statistically significant (P < 0.05). There was no complication associated with the use of IV-ECG.
  
  
  CONCLUSIONS
  IV-ECG is a safe and convenient method to help inexperienced operators placing TIVAD.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Wang
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Huang
authors.forename: Feng-Sheng
authors.initials: FS
authors.lastname: Lin
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Lin
authors.forename: Shou-Zen
authors.initials: SZ
authors.lastname: Fan
authors.forename: Chih-Peng
authors.initials: CP
authors.lastname: Lin
authors.forename: Wei-Zen
authors.initials: WZ
authors.lastname: Sun
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods*; D002983:Clinical Competence; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014683:Vena Cava, Superior