Intra-Cavitary ECG is an Effective Method for Correct Positioning of the Tip of Tunneled Groshong Catheters

Abstract

Intra-cavitary electrocardiography (ECG) is a well-known method for correct positioning of the tip of central venous catheters (CVC). A significant increase in the P wave, as registered by the intra-cavitary electrode, signals the entrance of the catheter into the right atrium. In this prospective observational study, 155 consecutive oncologic patients were enrolled for cannulation of the right or left internal jugular vein for insertion of a tunneled Groshong catheter. In 150 patients the tip was positioned by means of intracavitary ECG. Five patients with atrial fibrillation (N=4) or pacemaker in place (N=1) were excluded from the study. As the P-wave amplitude began to increase, the catheter was secured in that position and the insertion depth was registered. Intra-cavitary ECG was always apt to detect the increase in the P wave. On the post-operative chest x-ray all Groshong catheters except two were in the correct position. The need for chest x-ray or fluoroscopy may be virtually eliminated by using the ECG technique.