Central Venous Catheter-Induced Cardiac Tamponade

Abstract

Editori have read with great interest the review (1)written by Pittiruti et.al. followed by their multicenter study (2) regarding the use of EKG for central venous catheter (CVC) positioning.Late cardiac tamponade is a fatal complication that might arise if the CVC tip is left within the pericardial reflection by continuously eroding the atrial wall over time (3). it is there-fore that i do not understand why the authors in their study (2) aimed to position the CVCs so low. only procedures that require free blood flow (dialysis, hemofiltration, plasmapher-esis, etc.) are indications for a very low CVC position. in the review the authors claim that the EKG assisted CVC positioning technique is superior to fluoroscopy. Since EKG will position the CVC at the cava-atrial junction it will leave its tip within the pericardial reflection. Additional positioning as well as chest x-ray (CXR) is therefore required. Since CXR is needed to preclude other pathologies (such as pneumotho-rax) the use of expensive EKG catheters did not add any safety to the patients.The recommendations by Pittiruti in his review and study will expose patients to the danger of incorrect (deep) CVC position while using unnecessary expensive equipment. it is my recommendation to use the CVC lengths cited by Kim et. al. (4)and verify the position by CXR.