Assessment of Central Venous Catheterization Using Electrocardiographic versus Landmark Techniques in Pediatrics Undergoing Open Heart Surgery; Which Technique is Superior?

Abstract

Introduction: Central venous catheterization has been usually performed during major surgeries in order of central venous pressure assessment and fluid therapy. Variety of techniques has been performed for central venous catheterization previously but the information in this regard about pediatrics is limited. In the current study, the comparison of electrocardiographic technique with landmark one for central venous catheterization performance has been done. Methods: This is a cross-sectional study conducted on 75 patients underwent central venous catheterization for elective cardiovascular thoracic surgery. In the first step, the location of catheterization was estimated based on body surface landmarks. Then catheterization was done using electrocardiography. Then by cardio-surgeon aid, during open cardiac surgery, the catheter tip location was found (gold standard). Finally, chest X-ray was taken and catheter place based on radiological markers was recorded.Results: In the current study, 75 children with age under 18 years and gender distribution of 42.7% females and 57.3% males were assessed. Mean of central venous catheter depth in gold standard method was 7.5±1.35 centimeters. Significant association between central venous catheter placement in gold standard technique and both landmark and electrocardiographic was seen (P-value<0.001; r=0.94 and P-value<0.001; r=0.77). Logistic regression showed a significant association between weight and placement of catheter tip in landmark technique (P-value=0.038) as following formula (Depth of central venous catheter= 5.33+0.07*weight).Conclusion: Our study showed that the use of ECG for CVC considering carina-to-tip as reference was superior to the landmark. In addition, catheter tip correct position was affected by weight but not height based on landmark technique.