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< Vol. 13 Issue 3 | Jul-Sep 2012 | pp. 269 - 403

The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study

The intracavitary ECG method for positioning the tip of central venous catheters: results of an Italian multicenter study

J Vasc Access 2012; 13(3): 357 - 365

Article Type: ORIGINAL ARTICLE

DOI:10.5301/JVA.2012.9020

Authors

Mauro Pittiruti, Daniele Bertollo, Ermanno Briglia, Massimo Buononato, Giuseppe Capozzoli, Luigi De Simone, Antonio La Greca, Cecilia Pelagatti, Piersandro Sette

Abstract

Purpose: The aim of this multicenter study was to assess the feasibility, safety, and accuracy of the intracavitary ECG method for real-time positioning of the tip of different types of central venous catheters. Methods: A total of 1444 catheter insertions in adult patients were studied in eight Italian centers (539 ports, 245 PICCs, 325 tunneled CVCs, 335 non-tunneled CVCs). Patients with no visible P wave at the standard baseline ECG were excluded. Depending on the type of catheter and its purpose, the target was to position the tip either (a) at the cavo-atrial junction, or (b) in the lower third of the superior vena cava, or (c) in the upper part of the atrium. The final position was verified by a post-procedural chest x-ray. Results: The method was feasible in 99.3% of all cases. There were no complications potentially related to the method itself. At the final x-ray control, 83% of all tips were positioned exactly at the target; 12.4% were positioned within 1-2 cm from the target, but still in a correct central position; only 3.8% were malpositioned. The mismatch between intra-procedural ECG method and post-procedural x-ray was significantly lower when the x-ray was taken in supine position.Conclusions: Our multicenter study confirms that the intracavitary ECG method for real time verification of tip position is accurate, safe, feasible in all adult patients and applicable to any type of short-term or long-term central venous access device.

Article History

  • • Accepted on 21/11/2011
  • • Available online on 08/02/2012
  • • Published in print on 28/09/2012

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Authors

  • Pittiruti, Mauro [PubMed] [Google Scholar]
    Department of Surgery, Policlinico Universitario ‘A.Gemelli’, Roma - Italy
  • Bertollo, Daniele [PubMed] [Google Scholar]
    Department of Anesthesia and Intensive Care, Ospedale Civile di Varese, Varese - Italy
  • Briglia, Ermanno [PubMed] [Google Scholar]
    Department of Anesthesia and Intensive Care, Ospedale Castelnuovo Monti, Reggio Emilia - Italy
  • Buononato, Massimo [PubMed] [Google Scholar]
    Department of Surgery, Ospedali Riuniti di Cremona, Cremona - Italy
  • Capozzoli, Giuseppe [PubMed] [Google Scholar]
    Department of Anesthesia and Intensive Care, Ospedale Civile di Bolzano, Bolzano - Italy
  • De Simone, Luigi [PubMed] [Google Scholar]
    Department of Anesthesia and Intensive Care, Az. Osp. Universitaria di Pisa, Pisa - Italy
  • La Greca, Antonio [PubMed] [Google Scholar]
    Department of Surgery, Policlinico Universitario ‘A.Gemelli’, Roma - Italy
  • Pelagatti, Cecilia [PubMed] [Google Scholar]
    Department of Anesthesia and Intensive Care, Ospedale Careggi, Firenze - Italy
  • Sette, Piersandro [PubMed] [Google Scholar]
    Department of Anesthesia and Intensive Care, Ospedale Fracastoro, San Bonifacio - Italy

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