Central venous catheters--the inability of 'intra-atrial ECG' to prove adequate positioning

British Journal of Anaesthesia
Wolfram SchummerE Hüttemann

Abstract

The classic increase in P wave size, known as 'P-atriale', is a widely accepted criterion for determination of proper positioning of central venous catheter tips. Recent transoesophageal echocardiography (TOE) studies did not confirm intra-atrial position despite advancing the central venous catheter further than indicated by ECG guidance. We postulate that the pericardial reflection rather than the entry into the right atrium corresponds to the ECG changes. In order to test our hypothesis we sought to determine the anatomical substrate for the electrical changes in an animal study. Subsequently, a modified version of the study was undertaken in man and is also reported. In six juvenile pigs the left external jugular vein and right carotid artery were cannulated. A triple-lumen central venous catheter was positioned by ECG guidance using a Seldinger wire as an exploring electrode. The venous and arterial catheters were suture fixed 2 cm beyond the onset of an increase in P wave size. The corresponding anatomical catheter tip position was determined by open exploration of the vessels and the heart. Subsequently the catheter tip position (during advancement) of a pulmonary artery catheter and the corresponding electrical ECG chan...Continue Reading

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References

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Citations

Sep 22, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Yunseok JeonJae-Hyon Bahk
Feb 7, 2013·British Journal of Anaesthesia·F Gibson, A Bodenham
Jun 3, 2011·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Amit Jain
Apr 1, 2013·Journal of Vascular Surgery. Venous and Lymphatic Disorders·Mark C SvendsenGhassan S Kassab
Mar 9, 2010·Journal of Electrocardiology·Brigham SmithAndrew D Michaels
Mar 17, 2010·Veterinary Anaesthesia and Analgesia·Andrew K ClaudeElizabeth A Riedesel
Aug 7, 2007·Journal of Cardiothoracic and Vascular Anesthesia·Tiberiu EzriShmuel Evron
Dec 2, 2006·Journal of Cardiothoracic and Vascular Anesthesia·Ole BayerWolfram Schummer
Jun 15, 2011·The Journal of Vascular Access·Cecilia PelagattiAngelo Raffaele De Gaudio
Jun 15, 2011·The Journal of Vascular Access·Mauro PittirutiGiancarlo Scoppettuolo
Aug 16, 2017·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Devinder MidhaAmit Kumar Mandal
Dec 21, 2006·Anesthesia and Analgesia·Ralf E GebhardRobert D Warters
May 12, 2009·Yonsei Medical Journal·Dilek KaraaslanSadik Ozmen
May 6, 2019·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Lucy R HintonSeyed Ali Mirjalili
Nov 26, 2011·Anesthesia and Analgesia·Wolfram Schummer
Oct 18, 2019·Annals of Cardiac Anaesthesia·Abhijit S NairBasanth Kumar Rayani
Feb 19, 2019·Journal of Vascular and Interventional Radiology : JVIR·Eric J KellerJeremy D Collins
Jan 18, 2006·British Journal of Anaesthesia·P A Stonelake, A R Bodenham
Nov 15, 2021·Journal of Infusion Nursing : the Official Publication of the Infusion Nurses Society·Emily DiLoreto, Amit Bahl

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