ACCURATE PLACEMENT OF CENTRAL VENOUS CATHETERS IN PEDIATRIC-PATIENTS USING ENDOCAVITARY ELECTROCARDIOGRAPHY - REASSESSMENT OF A PERSONAL TECHNIQUE

To avoid the need for radiological control in the assessment of the pr oper location bf central venous catheters (CVC), a particular use of e ndocavitary electrocardiography (EC-ECG) was proposed 10 years ago. Th e aim of this study is to reassess our experience with this method. EC -ECG assumes that the CVC, when filled with normosaline and connected to a standard electrocardiograph, behaves like an exploring electrode. The approach of the catheter tip to the right atrium is then detected by a slightly increasing negative P wave. When the tip reaches the ex act level of the Sinus node, the P wave suddenly deepens. After a prel iminary test of the reliability of the technique versus the standard m ethod in 50 CVC placements verified by both EC-ECG and chest x-ray, we have placed 807 CVCs in children using EC-ECG only. There have been n o false-positive and one false-negative test result (lead connector mi splacement). In 17 cases in which intrinsic deflection was not detecte d, the catheter tip was found to be wrongly positioned; all the remain der CVCs have been successfully positioned. For 10 years this techniqu e has proved to be a simple, safe, quick, inexpensive and highly relia ble method to assess the correct positioning of the CVC. Copyright (C) 1997 by W.B. Saunders Company.