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VOLUME 12 , ISSUE 1 ( March, 2008 ) > List of Articles

REVIEW ARTICLE

Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula

Veena R. Shah, Geeta P. Parikh, Anish M. Joshi, Guruprasad P. Bhosale

Keywords : Central venous catheterization, intra-atrial electrocardiography, Peres′ height formula

Citation Information : Shah VR, Parikh GP, Joshi AM, Bhosale GP. Optimal positioning of right-sided internal jugular venous catheters: Comparison of intra-atrial electrocardiography versus Peres′ formula. Indian J Crit Care Med 2008; 12 (1):10-14.

DOI: 10.4103/0972-5229.40943

License: CC BY-ND 3.0

Published Online: 01-03-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Central venous catheters are routinely placed in patients undergoing major surgeries where expected volume and hemodynamic disturbances are likely consequences. The incorrect positioning may give false central venous pressure (CVP) readings leading to incorrect volume replacement and other serious complications. 50 American Society of Anaesthesiologists grade II-IV patients aged 18-60 years were selected for right-sided internal jugular vein (IJV) catheterization using Seldinger′s technique. In group A, central venous catheterization was done under electrocardiography (ECG) guidance. In group B, the catheter was inserted blindly using Peres′ formula of “height (in cm)/10”. The position of the tip of central venous catheter was confirmed radiologically by postoperative chest X-ray. 92% of patients in group A had radiologically correct positioning of catheter tip i.e. above the carina, while in group B 48% patients had over-insertion of the catheter in to the right atrium. Intra-atrial ECG technique to judge correct tip positioning is simple and economical. It can determine the exact position intraoperatively and can justify a delayed postoperative chest X-ray to confirm CVC line tip placement.


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  1. Cardiac tamponade from central venous catheters. Anesthesiology 1979;50:249-52.
  2. The carina as a radiological landmark in central venous catheter placement. Br J Anaesth 2000;85:192-4.
  3. The carina as a radiological landmark for central venous catheter tip position. Br J Anaesth 2006;96:335-40.
  4. Evaluation of formulas for optimal positioning of central venous catheters. Chest 1995;107:1662-4.
  5. Depth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position. Anesth Intensive Care 1998;26:61-6.
  6. Right atrial electrocardiography in placement of central venous catheters. Lancet 1988;27:462-3.
  7. Transesophageal echocardiographic evaluation of ECG-guided central venous catheter placement. Can J Anesth 2006;53:978-83.
  8. A controlled study of transesophageal echocardiography to guide central venous catheter placement in congenital heart surgery patients. Anesth Analg 1999;89:65-70.
  9. Positioning central venous catheters: A prospective survey. Anesth Intensive Care 1990;18:536-9.
  10. Recording of intracavity potentials through a single lumen, saline filled cardiac catheter. Proc Soc Exp Med 1949;71:58-60.
  11. Safe placement of central venous catheters: Where should the tip of the catheter lie? Br J Anaesth 2000;85:188-91.
  12. Depth of central venous catheterization: An audit of practice in a cardiac surgical unit. Anaesth Intensive Care 1994;22:267-71.
  13. Safe placement of central venous catheters. Br J Anaesth 2006;97:584-5.
  14. Applied anatomy of the superior vena cava-the carina as a radiological landmark to guide central venous catheter placement. Br J Anaesth 2004;92:75-7.
  15. Usefullness of the carina as a radiological landmark for central vanous catheter placement in paediatric patients. Br J Anaesth 2005;95:514-7.
  16. A better landmark for positioning a central vanous catheter. J Clin Monit Comput 2002;17:331-4.
  17. Use of electrocardiogram to position right atrial catheters during surgery. Ann Surg 1997;225:165-71.
  18. Avoiding complications and decreasing costs of central venous catheter placement electrocardiographic guidance. Surg Gynecol Obstet 1992;175:208-11.
  19. The Accuracy of electrocardiogram controlled central line placement Anesth Analg 2007;104:65-70.
  20. Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters. Br J Anaesth 2003;91:481-6.
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