EKG Guided Placement of Subclavian CVP Catheters Using J-Wire

Abstract

In an attempt to improve the accuracy of central venous pressure (CVP) catheter tip location, 84 consecutive cardiac surgery patients in sinus rhythm were studied prospectively with respect to subclavian insertion of a CVP catheter using a guidewire technique. The presence of cardiac arrhythmia was used as an index of right atrial (RA) location of the guidewire tip, before threading the catheter over the guidewire. Correct catheter tip location (superior vena cava [SVC] or RA) was achieved in 100% of patients (N = 78) with premature atrial contractions (PACs) related to guidewire insertion. This fell to 50% (N = 4) if no arrhythmias were noted from the guidewire. Ventricular arrhythmias were noted in two of 84 patients (2.4%). Other problems related to the use of this technique are discussed.

Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables

“…The IJV vein occlusion test and the saline flush test are the most common methods for rapid diagnosis of a misplaced SCV into the IJV (Ambesh et al, 2001;Rath et al, 2009). Electrocardiograph (ECG) guiding for catheterization of SCV can decrease the malposition, but this method is not advisable for a patient with rhythm disturbance (Starr and Cornicelli, 1986;Goel et al, 2010). In addition, it is implicit for misplacement that there is ear pain in the process of catheterization (Dubey and Kumar, 2002).…”

Accurate nonfluoroscopic guidance and tip location of peripherally inserted central catheters using a conductance guidewire system

“…26 In addition, conductance is more direct than other nonfluoroscopic PICC navigation and tip location technologies such as electrocardiographic, Doppler flow, and stylet-aided magnetic guidance. [14][15][16][17][18][19][20] Electrocardiographic and Doppler flow methods have been controversial and not widely adopted in the clinic, while stylet-aided magnetic guidance provides a nonanatomically based relative assessment of PICC position. These and other bedside guidance technologies (eg, SwanGanz catheters 27 ) exist and rely on physiological measurements to confirm catheter location.…”

A Unique Case of Accidental Ipsilateral Retrograde Internal Juglar Vein Cannulation

“…ECG guidance and presence of arrhythmias guide about the placement of the tip in the superior vena cava. [6] A USG reduces complications like arterial cannulation but it does not guide about the tip placement. The placement of CVC tip at the superior vena cava-right atrial junction is most accurately detected by Trans Esophageal Echocardiography and fluoroscopy but it is not always feasible due to lack of equipment or high cost.…”