Reliability of intra-atrial ECG method of insertion of central venous line through right internal jugular vein when compared to formula and radiological landmark method: a prospective randomized study

Abstract

BackgroundIdeal position of central venous catheter tip should be within 2 cm above and 1 cm below superior vena cava–right atrium (SVC-RA) junction. The objective of the study was to compare intra-atrial ECG method of Central venous catheterization of right internal jugular vein (IJV) with traditional methods. A prospective randomized trial enrolling 90 patients were alternatively allocated to three groups and comparison of intra-atrial electrocardiography, radiological landmark and Pere’s formula method for correct positioning of central venous catheter tip were done and tip position were confirmed with post-procedural TEE (transesophageal echocardiography).ResultsCatheter tip was present at the ideal position in 100% cases in intra-atrial ECG method compared to only 23.4% in formula method and 93.3% in landmark method (p value 0.001). In intra-atrial method group, the central venous catheter tip was placed perfectly in all patients, position of the catheter tip was not acceptable in 71.4% of the patients where formula method is used and not acceptable in 11.1% when landmark method is used (p value 0.001). However, we did not encounter any catheter related complications in any of these groups.ConclusionsIntra-atrial ECG method carries the advantage of ideal positioning of the central venous catheter tip by right IJV route in almost all cases when compared to conventional formula and landmark method to some extent. Also, immediate confirmation and real time verification of central venous catheter (CVC) tip is possible, thereby avoids the need for post-procedural chest X-ray and other methods of central venous placement confirmation like arterial blood gas analysis etc., Hence, intra-atrial ECG method is cost effective and safer for confirmation of CVC tip in all the situations.