The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study.
OBJECTIVE
The aim of this multicenter study was to assess the feasibility, safety, and accuracy of the intracavitary ECG method for real-time positioning of the tip of different types of central venous catheters.


METHODS
A total of 1444 catheter insertions in adult patients were studied in eight Italian centers (539 ports, 245 PICCs, 325 tunneled CVCs, 335 non-tunneled CVCs). Patients with no visible P wave at the standard baseline ECG were excluded. Depending on the type of catheter and its purpose, the target was to position the tip either (a) at the cavo-atrial junction, or (b) in the lower third of the superior vena cava, or (c) in the upper part of the atrium. The final position was verified by a post-procedural chest x-ray.


RESULTS
The method was feasible in 99.3% of all cases. There were no complications potentially related to the method itself. At the final x-ray control, 83% of all tips were positioned exactly at the target; 12.4% were positioned within 1-2 cm from the target, but still in a correct central position; only 3.8% were malpositioned. The mismatch between intra-procedural ECG method and post-procedural x-ray was significantly lower when the x-ray was taken in supine position.


CONCLUSIONS
Our multicenter study confirms that the intracavitary ECG method for real time verification of tip position is accurate, safe, feasible in all adult patients and applicable to any type of short-term or long-term central venous access device.
Department of Surgery, Policlinico Universitario 'A.Gemelli', Roma, Italy. mauro.pittiruti@rm.unicatt.it
Mauro
M
Pittiruti
Daniele
D
Bertollo
Ermanno
E
Briglia
Massimo
M
Buononato
Giuseppe
G
Capozzoli
Luigi
L
De Simone
Antonio
A
La Greca
Cecilia
C
Pelagatti
Piersandro
P
Sette
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D004562:Electrocardiography; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D055815:Young Adult