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CARDIOVASCULAR ANESTHESIA

The Accuracy of Electrocardiogram-Controlled Central Line Placement

Ralf E. Gebhard, MD^*, Peter Szmuk, MD, Evan G. Pivalizza, MBChB, FFASA, Vladimir Melnikov, MD, Christianne Vogt, MD, and Robert D. Warters, MD

From the *Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, Florida; Department of Anesthesiology, The University of Texas Southwestern Medical School at Dallas and Children's Medical Center Dallas, Dallas; and Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas.

BACKGROUND: Electrocardiogram (ECG) guidance to confirm accurate positioning of central venous catheters (CVC), placed before surgery in the operating room, is rarely used in the United States. We designed this randomized, controlled trial to investigate whether the use of this technique impacts the accuracy of CVC placement.

METHODS: Patients in group ECG (n = 147) had a CVC placed using right-atrial ECG to guide catheter tip positioning. CVCs in group NO-ECG (n = 143) were positioned without this technique.

RESULTS: Overall, guidewire-ECG control resulted in more correctly positioned CVCs (96% vs 76%, P 0.001) without increasing placement time. Significantly more CVCs were placed in the middle of the superior vena cava in group ECG (P 0.001), although placement into the right atrium or right ventricle and into other vessels occurred significantly more often in group NO-ECG (P 0.001). Twenty patients in group NO-ECG required repositioning of their CVC after surgery, whereas this maneuver was necessary only in three patients in group ECG (P 0.001).

CONCLUSIONS: ECG guidance allows for more accurate CVC placement, and should be considered to increase patient safety and reduce costs associated with repositioning procedures.

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