title: A comparative study of two techniques (electrocardiogram- and landmark-guided) for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery.
abstract: OBJECTIVE
  The complications of central venous catheterisation can be minimized by ensuring catheter tip placement just above the superior vena cava-right atrium junction. We aimed to compare two methods, using an electrocardiogram (ECG) or landmark as guides, for assessing correct depth of central venous catheter (CVC) placement.
  
  
  METHODS
  In a prospective randomised study of sixty patients of <12 years of age, thirty patients each were allotted randomly to two groups (ECG and landmark). After induction, central venous catheterisation was performed by either of the two techniques and position of CVC tip was compared in post-operative chest X-ray with respect to carina. Unpaired t-test was used for quantitative data and Chi-square test was used for qualitative data.
  
  
  RESULTS
  In ECG group, positions of CVC tip were above carina in 12, at carina in 9 and below carina in 9 patients. In landmark group, the positions of CVC tips were above carina in 10, at carina in 4 and below carina in 16 patients. Mean distance of CVC tip in ECG group was 0.34 ± 0.23 cm and 0.66 ± 0.35 cm in landmark group (P = 0.0001). Complications occurred in one patient in ECG group and in nine patients in landmark group (P = 0.0056).
  
  
  CONCLUSIONS
  Overall, landmark-guided technique was comparable with ECG technique. ECG-guided technique was more precise for CVC tip placement closer to carina. The incidence of complications was more in the landmark group.
authors: Department of Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors: Neeraj Kumar
authors: NK
authors: Barnwal
authors: Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors: Sona T
authors: ST
authors: Dave
authors: Department of Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
authors: Raylene
authors: R
authors: Dias
keywords: Carina; central venous catheter; chest X-ray; electrocardiogram; landmark; paediatric