title: The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study.
abstract: OBJECTIVE
  The Italian Group for Venous Access Devices (GAVeCeLT) has carried out a multicenter study investigating the safety and accuracy of intracavitary electrocardiography (IC-ECG) in pediatric patients.
  
  
  METHODS
  We enrolled 309 patients (age 1 month-18 years) candidate to different central venous access devices (VAD) - 56 peripherally inserted central catheters (PICC), 178 short term centrally inserted central catheters (CICC), 65 long term VADs, 10 VADs for dialysis - in five Italian Hospitals. Three age groups were considered: A (<4 years, n = 157), B (4-11 years, n = 119), and C (12-18 years, n = 31). IC-ECG was applicable in 307 cases. The increase of the P wave on IC-ECG was detected in all cases but two. The tip of the catheter was positioned at the cavo-atrial junction (CAJ) (i.e., at the maximal height of the P wave on IC-ECG) and the position was checked during the procedure by fluoroscopy or chest x-ray, considering the CAJ at 1-2 cm (group A), 1.5-3 cm (group B), or 2-4 cm (group C) below the carina.
  
  
  RESULTS
  There were no complications related to IC-ECG. The overall match between IC-ECG and x-ray was 95.8% (96.2% in group A, 95% in group B, and 96.8% in group C). In 95 cases, the IC-ECG was performed with a dedicated ECG monitor, specifically designed for IC-ECG (Nautilus, Romedex): in this group, the match between IC-ECG and x-ray was 98.8%.
  
  
  CONCLUSIONS
  We conclude that the IC-ECG method is safe and accurate in the pediatric patients. The applicability of the method is 99.4% and its feasibility is 99.4%. The accuracy is 95.8% and even higher (98.8%) when using a dedicated ECG monitor.
authors.affiliation: 1 Department of Anesthesia, Children's Hospital 'Meyer', Firenze - Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossetti
authors.forename: Mauro
authors.initials: M
authors.lastname: Pittiruti
authors.forename: Massimo
authors.initials: M
authors.lastname: Lamperti
authors.forename: Ugo
authors.initials: U
authors.lastname: Graziano
authors.forename: Davide
authors.initials: D
authors.lastname: Celentano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Capozzoli
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007558:Italy; D056888:Patient Positioning; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation