Siting central venous catheters precisely by means of the ECG method - A Reliability Study

Abstract

Abstract Introduction: For central venous catheters (CVC) to function properly, optimal tip location is of utmost importance. One technique to verify CVC position is the ECG method. Nowadays, the ECG method is applied using the maximum P-wave amplitude (P-max). The hypothesis is that a method believed to be precise in assessing CVC position can provide the same results for CVC tip positions regardless of their respective insertion sites. Methods: Only critically ill patients with multiple organ dysfunction were eligible for the study. Another condition was a prerequisite for reliable illustration of the results, i.e. at least two central venous lines had to be in place. All catheters were placed using the ECG method with the CVC tip at P-max. In all patients, a chest X-ray was performed within 24 hours of line insertion to assess the CVC positions. Results: Between January 2018 and December 2020, 51 critically ill patients with more than one CVC concurrently in place were deemed eligible and were included in the study. The distance between the inserted CVC tips was measured using the picture archiving and communication system (PACS). Across 51 patients, the mean difference between the two central lines inserted was 0.31 cm. The median was 0.00 cm, indicating that more than half of the sample exhibited no difference in positioning. Conclusion: The ECG method of placing the CVC tip at P-max is a stable and reliable bedside method for positioning CVCs as the results for double CVCs impressively underline and it already works during the access procedure. However, the results demand confirmation in further studies.