MONITORING OF CENTRAL VENOUS DUAL-LUMEN CATHETER PLACEMENT IN HEMODIALYSIS - IMPROVEMENT OF A TECHNIQUE FOR THE PRACTICING NEPHROLOGIST

Mismanagement in the placement of central venous catheter (CVC) may oc cur in up to 20% of cases. The catheter can be inadvertently placed in the contralateral brachiocephalic vein, the ipsi or contralateral int ernal jugular vein, and usually a thoracic radiograph is necessary to evaluate its location. We propose a technique first described by Seraf ini er al. to establish the position of a CVC by endocavitary electroc ardiography (EC-ECG) and its employment in a large number of uraemic p atients requiring haemodialysis. This technique uses the tip of the CV C as reference lead in a standard electrocardiograph. The best employm ent of this technique has been obtained by echotomographic visualizati on of the internal jugular vein executed just before transcutaneous pu ncture of the vessel. For 13 months we have successfully applied this technique in CVC placement in 81 patients requiring haemodialysis. In our opinion this method is a safe and simple technique that avoids the need for thoracic radiographs and time lost waiting for radiographs t hat prolong the start of the haemodialysis session. According to our e xperience, we confirm that the EC-ECG technique provides a method for ensuring compliance with Food and Drug Administration guidelines regar ding catheter tip location in uraemic patients.