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LETTER TO THE EDITOR

Atrial Electrocardiogram for Verification of Correct Central Venous Catheter Placement

Associate Professor of Anesthesiology; University of Miami — Miller School of Medicine; Miami, Florida; rgebhard{at}med.miami.edu (Gebhard)

In Response:

Saager et al. (1) are correct that electrocardiogram (ECG) guidance has been described previously as a technique to verify central venous catheter (CVC) placement (2,3). However, our investigation (4) is the first large prospective randomized trial that demonstrates that ECG guidance is actually more accurate than the conventional techniques used for CVC placement. Therefore, our trial provides strong evidence to support Saager et al.'s suggestion that ECG guidance should be routinely used for CVC placement. We are also aware of Engelhardt et al.'s publication (5) regarding the placement of central venous catheter with ECG guidance in patients with atrial fibrillation. Although this case series of 40 consecutive patients suggests that ECG guidance can be used even in patients with atrial fibrillation, we choose to exclude patient with this condition from our investigation to simplify our study design.

REFERENCES

1. Saager L, Wiesner E, Pestel G, Rothhammer A. Atrial Electrocardiogram for verification of correct central venous catheter placement. Anesth Analg 2007;105:1511[Free Full Text]
2. Martin JT. Neuroanesthetic adjuncts for patients in the sitting position. 3. Intravascular electrocardiography. Anesth Analg 1970;49:793–808[Free Full Text]
3. Baar H, Danhauser I, Rothhammer A. Lagekontrolle zentralvenoser Katheter mit dem intrakardialen EKG. Eine Darstellung der Methode und ihrer Vorzuge gegenuber der Rontgen-Kontrolle. Fortschr Med 1984;102:755–6[Web of Science][Medline]
4. Gebhard RE, Szmuk P, Pivalizza EG, Melnikov V, Vogt C, Warters RD. The accuracy of electrocardiogram-controlled central line placement. Anesth Analg 2007;104:65–70[Abstract/Free Full Text]
5. Englelhardt W, Sold M, Helzel MV. ECG-controlled placement of central venous catheters in patients with atrial fibrillation. Anaesthesist 1989;38:476–9[Web of Science][Medline]

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