Cavoatrial Junction and Central Venous Anatomy: Implications for Central Venous Access Tip Position

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.

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The intracavitary electrocardiography method for tip location of jugular internal vein access device in infants of less than 5 kg: A pilot study

The Journal of Vascular Access ◽

10.1177/1129729818769028 ◽

2018 ◽

Vol 19 (6) ◽

pp. 639-643 ◽

Cited By ~ 2

Author(s):

Rossella Mastroianni ◽

Antonella Capasso ◽

Gaetano Ausanio

Keyword(s):

Neonatal Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

P Wave ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Vein Access ◽

Tip Position ◽

Venous Access Device

Purpose: This is a prospective observational study conducted by neonatologists in neonatal intensive care unit from Sant’Anna and San Sebastiano Hospital, Caserta, Italy. The objective of the study is to verify the feasibility of intracavitary electrocardiography method for tip location of central venous access device in infants of less than 5 kg and evaluate the accuracy of the method in comparison with post-procedural echocardiographical verification of the tip position. Patients and methods: We enrolled 27 patients weighted between 0.660 and 5 kg, requiring central vascular access. Ultrasound-guided jugular internal vein access was used and after cannulation, we applied the intracavitary electrocardiography for tip location as well as post-procedural echocardiography. Results: No significant complication related to intracavitary electrocardiography occurred in the studied infants. The increase in P wave on intracavitary electrocardiography was detected in all cases (27/27). In only one case (false positive), the catheter had the tip out of cavoatrial junction–target zone (to post-procedural echocardiography). Conclusion: The intracavitary electrocardiography method for tip location of central venous access device is safe and accurate in infants, as demonstrated by post-procedural comparative echocardiographic controls. As an alternative to echocardiography, not always achievable, the diffusion of intracavitary electrocardiography method could reduce X-ray exposition and complications of a malpositioned tip.

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