[Extravasal position of central venous catheters despite unsuspicious ECG-guidance]. / Extravasale Lage von zentralen Venenkathetern bei korrekter EKG-Ableitung.
Anasthesiol Intensivmed Notfallmed Schmerzther
; 40(2): 91-6, 2005 Feb.
Article
en De
| MEDLINE
| ID: mdl-15714399
ABSTRACT
OBJECTIVE:
Does the electrocardiographic method for central venous catheter positioning distinguish between a correct intravasal and a malpositioned extravasal position?METHODS:
24 cardiac surgical patients were enrolled in this prospective observational study. In 18 patients the left, in another 6 patients the right internal jugular vein was cannulated. Using a J-wire within a triple-lumen catheter the amplitude of the P-wave was measured at 3 different intravasal sites Intra-1 (intravasal baseline electrocardiogram), i. e. 10 cm marking of the catheter on skin level; Intra-2 clear rise of the P-wave amplitude upon further insertion of the catheter; Intra-3 maximum P-wave amplitude. At this position the control of the catheter tip was achieved by means of transoesophageal echocardiography (TOE). Intraoperatively, another J-wire within a triple-lumen catheter was placed by the heart surgeon on 3 extravasal sites and the ECG was recorded Extra-1 extravasal at the left innominate vein above the pericardial reflection; Extra-2 extravasal on the superior vena cava below the pericardial reflection; Extra-A extravasal on ascending aorta below the pericardial reflection. The catheter was suture fixed with its tip in position Intra-3. Post surgery a chest radiograph was taken.RESULTS:
All catheter tips were visualised at the basis of the Crista terminals (border between right atrium and superior vena cava) by TOE control. The rise of the P wave amplitude at Intra-2, Extra-2 and Extra-A was highly significant compared to the base line at Intra-1 (Intra-1/Intra-2, Intra-1/Extra-2, Intra-1/Extra-A p in each case < 0.001). The P wave amplitudes of the corresponding intra- and extravasal positions of the left innominate vein (Intra-1/Extra-1, n = 18, p = 0.096)) as well as those of the superior vena cava (Intra-2/Extra-2, n = 24, p = 0.859) did not differ.CONCLUSION:
The electrocardiographic method can not differentiate between intra- and extravasal position of a central venous catheter, and thus, presumably fails to identify malpositioning as a result of vascular perforation.
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Banco de datos:
MEDLINE
Asunto principal:
Cateterismo Venoso Central
/
Errores Médicos
/
Electrocardiografía
Tipo de estudio:
Guideline
/
Observational_studies
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
De
Revista:
Anasthesiol Intensivmed Notfallmed Schmerzther
Asunto de la revista:
ANESTESIOLOGIA
/
MEDICINA DE EMERGENCIA
/
TERAPIA INTENSIVA
Año:
2005
Tipo del documento:
Article