title: Peroperative electrocardiographic control of catheter tip position during implantation of femoral venous ports.
abstract: OBJECTIVE
  Electrocardiographic (ECG) guidance has been shown to be as effective than fluoroscopy to position the tip of central venous devices close to the superior vena cava (SVC)-right atrium (RA) junction. When SVC access is contraindicated, a femoral access may be used. The aim of this prospective study is to evaluate the effectiveness of ECG guidance to position the tip of femoral ports at inferior vena cava (IVC)-RA junction.
  
  
  METHODS
  Inclusion criterion was the need for femoral port implantation. After insertion of the dilator in the femoral vein, the catheter with the guide wire inside was introduced and the ECG signal collected at the tip of the guide (Celsite™ ECG, B. Braun, Germany) or via saline injected in the catheter (Nautilus™, Perouse, France). Fluoroscopy was performed at each change of the P-wave from IVC to RA. A final X-ray was performed after withdrawing the catheter 2 cm below the first P-wave change.
  
  
  RESULTS
  A total of 18 patients were included between December 2011 and June 2013. The P-wave was most often negative in IVC, biphasic when the catheter entered RA and giant and positive at the top of RA. When the catheter was withdraw 2 cm below the first biphasic P-wave the tip was just below the IVC-RA junction in 17 patients. In one patient P-wave changes were not significant and the final position was adjusted under fluoroscopy.
  
  
  CONCLUSIONS
  ECG guidance is effective to assess catheter tip position during femoral port placement and avoids the need for radiological methods.
authors.affiliation: Hospices civils de Lyon, Department of Anesthesiology, Centre Hospitalier Lyon Sud, Pierre Bénite - France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gibault
authors.forename: Eric
authors.initials: E
authors.lastname: Desruennes
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bourgain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling; D002648:Child; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult