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CARDIOVASCULAR ANESTHESIA

Accurate Central Venous Port-A Catheter Placement: Intravenous Electrocardiography and Surface Landmark Techniques Compared by Using Transesophageal Echocardiography

Koung-Shing Chu, MD^*, Jong-Hau Hsu, MD, Shie-Shan Wang, MD, Chao-Shun Tang, PhD, Kuang-I Cheng, MD, Chien-Kuo Wang, MD^||, and Jiunn-Ren Wu, MD

*Department of Anesthesiology, Kuo General Hospital, Tainan, Taiwan; and Departments of Pediatrics, Surgery, Anesthesiology, and Medical Imaging, Kaohsiung Medical University, Kaohsiung City, Taiwan

Address correspondence and reprint requests to Kuang-I Cheng, MD, No. 100, Shih-Chuan 1st Rd., Department of Anesthesiology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China. Address e-mail to kuaich{at}kmu.edu.tw

Using transesophageal echocardiography (TEE) to locate the tip of central venous catheters inserted via the right subclavian vein, we compared IV electrocardiography (IV-ECG)-guided catheter tip placement with the conventional surface landmark technique. Sixty patients were randomly assigned into two groups. In Group E, the IV-ECG signal was conducted along an NaHCO₃-filled catheter to facilitate catheter placement. In Group S, surface landmarks on the chest wall were used to determine the appropriate catheter length. The goal was to visualize the catheter tip with TEE at the superior edge of the crista terminalis, which is the junction of the superior vena cava (SVC) and right atrium (RA). The catheter tip position was considered to be satisfactory, as the tip was within 1.0 cm of the upper crista terminalis edge. All 30 Group E patients had satisfactory catheter tip placement when the ECG P wave was at its maximum. In contrast, 16 of the 30 patients in Group S had satisfactory tip positions (P < 0.001). All catheters were repositioned under TEE guidance to adjust the tip to the SVC-RA junction. After the catheter tips were confirmed to be located at the SVC-RA junction, the catheter tips were still visualized in the mid portion of RA in 12 of 60 patients on supine chest radiographs. We concluded that IV-ECG guidance to position a catheter resulted in satisfactory catheter tip placement that is in accordance with TEE views. Catheter placement at the SVC-RA junction with the surface landmark technique was unreliable.

IMPLICATIONS: Intravenous electrocardiography guidance to position catheters obtains a satisfactory catheter tip placement that is in accordance with transesophageal echocardiography views. The surface landmark technique does not result in reliable placement at the superior vena cava-right atrium junction.

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