A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients

Transesophageal echocardiography (TEE) and central venous catheter (CVC) pl acement are often used during congenital cardiac surgery. Complications of CVC placement include cardiac perforation, inadvertent arterial placement, and erroneous hemodynamic data from unrecognized malposition. In this study , we used a prospective, randomized, controlled design to evaluate the use of TEE to guide depth of insertion and confirm superior vena cava cannulati on, and to improve the percentage of correctly placed CVCs and reduce compl ications of CVC placement. One hundred forty-five patients were studied. Ei ghty patients were randomized to have subclavian vein insertion, 64: to hav e internal jugular insertion, and 1 to have external jugular insertion of C VC. TEE-guided CVC placement resulted in 100% correct placement when assess ed by preoperative TEE, versus 86% in the control group (72 of 72 vs 63 of 73; P = 0.01). There was no difference in correct placement between the two groups when assessed by postoperative chest radiograph (81.9% TEE versus 7 5.3% control; P = not significant). One significant complication, a superio r vena cava perforation, occurred in the control group. Time to placement w as 9.6 min in the TEE group versus 8.0 min in the control group (P = 0.015) . Implications: Transesophageal echocardiography can be used to guide centr al venous catheter placement in con genital heart surgery. Central venous c atheters that seem to be located high in the right atrium by chest radiogra ph in these patients are often actually in the superior vena cava and pose little risk of cardiac perforation.