Intracavitary electrocardiography for tip location during central venous catheterization: A narrative review of 70 years of clinical studies

Intracavitary electrocardiography is an accurate and non-invasive method for central venous access tip location. Using the catheter as a traveling intracavitary electrode, intracavitary electrocardiography is based on the increase in the detected amplitude of the P wave while approaching the cavoatrial junction. Despite having been adopted diffusely in clinical practice only in the last years, this method is not novel. In fact, it has first been described in the late 40s, during electrophysiological studies. After a long period of quiescence, it is in the last two decades of the XX century that intracavitary electrocardiography became popular as an effective mean of central venous catheters tip location. But the golden age of this technique began with the new millennium, as documented by high-quality studies in this period. In fact, in those years, intracavitary electrocardiography has been studied broadly, and important achievements in terms of comprehension of the technique, accuracy, and feasibility of the method in different populations and conditions (i.e. pediatrics, renal patients, atrial fibrillation) have been gained. In this review, we describe the technique, its history, and its current perspectives.

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Ultrahangvezérelt centrálisvéna-biztosítás korrigálatlan coagulopathiában

Orvosi Hetilap ◽

10.1556/650.2015.30194 ◽

2015 ◽

Vol 156 (27) ◽

pp. 1085-1090

Author(s):

Géza Reusz ◽

Csilla Langer ◽

Tibor Hevessy ◽

Ákos Csomós

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Central Venous Catheterization ◽

Central Venous Access ◽

Venous Access ◽

Bleeding Complications ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

Clopidogrel Therapy

Introduction: Correction of coagulopathy prior to central venous catheterization is a standard practice. Before ultrasound-guided procedures, routine correction of coagulopathy is controversial as mechanical complications are rare. Aim: To evaluate the safety of ultrasound-guided central venous access in critically ill patients with coagulopathy. Method: In this retrospective study the authors included all ultrasound-guided central venous catheterizations performed in their Intensive Care Unit between February 2011 and January 2013. They defined coagulopathy as INR or APTT ratio above 1.5, platelet count below 100 G/l, and anticoagulation or clopidogrel therapy. Data obtained from ultrasound register and patient records were used. Results: 310 ultrasound-guided central venous catheterizations were performed. Coagulopathy was observed in 134 cases (43.2%) and corrected in 10 cases prior to catheterization. There were no bleeding complications (complication rate in uncorrected coagulopathy: 0%, 95% confidence interval: 0-3.0%). Conclusions: Coagulopathy is common in critically ill patients, but its routine correction prior to ultrasound-guided central venous catheterization seems unnecessary. Orv. Hetil., 2015, 156(27), 1085–1090.

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External jugular venous catheterization with a Groshong catheter for central venous access

Journal of Surgical Oncology ◽

10.1002/jso.21064 ◽

2008 ◽

Vol 98 (1) ◽

pp. 67-69 ◽

Cited By ~ 7

Author(s):

Mitsuru Ishizuka ◽

Hitoshi Nagata ◽

Kazutoshi Takagi ◽

Keiichi Kubota

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Venous Catheterization

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Vias para Nutrição Artificial na Criança (II): Acessos Parentéricos

Acta Médica Portuguesa ◽

10.20344/amp.5313 ◽

2014 ◽

Vol 27 (6) ◽

pp. 767

Author(s):

José Estevão-Costa

Keyword(s):

Parenteral Nutrition ◽

Central Venous Catheterization ◽

Venous Catheter ◽

Venous Access ◽

The Body ◽

Central Catheter ◽

Maintenance Care ◽

Central Venous ◽

Venous Catheterization

Parenteral nutrition is crucial when the use of the gastrointestinal tract is not feasible. This article addresses the main techniques for parenteral access in children, its indications, insertion details and maintenance, and complications. The type of venous access is mainly dictated by the expected duration of parenteral nutrition and by the body weight/stature. The peripheral access is viable and advantageous for parenteral nutrition of short duration (< 2 weeks); a tunneled central venous catheter (Broviac) is usually necessary in long-term parenteral nutrition (> 3 weeks); a peripherally introduced central catheter is an increasingly used alternative. Parenteral<br />accesses are effective and safe, but the morbidity and mortality is not negligible particularly in cases of short bowel syndrome. Most complications are related to the catheter placement and maintenance care, and can be largely avoided when the procedures are carried out by experienced staff under strict protocols.<br /><strong>Keywords:</strong> Child; Parenteral Nutrition; Catheterization, Central Venous; Catheterization, Peripheral.

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A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study

The Journal of Vascular Access ◽

10.1177/1129729819838135 ◽

2019 ◽

Vol 20 (6) ◽

pp. 630-635

Author(s):

Minmin Yao ◽

Wanxia Xiong ◽

Liying Xu ◽

Feng Ge

Keyword(s):

Observational Study ◽

Success Rate ◽

Central Venous Access ◽

Demographic Data ◽

Venous Access ◽

Axillary Vein ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

Out Of Plane

Background: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. Methods: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients’ demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. Results: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. Conclusion: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.

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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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Percutaneous central venous catheterization in children: First line choice for venous access

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(86)80387-6 ◽

1986 ◽

Vol 21 (8) ◽

pp. 685-688 ◽

Cited By ~ 29

Author(s):

Barry M. Newman ◽

Theodore C. Jewett ◽

Melvyn P. Karp ◽

Donald R. Cooney

Keyword(s):

Central Venous Catheterization ◽

Venous Access ◽

First Line ◽

Central Venous ◽

Venous Catheterization ◽

Children First

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Cardiovascular monitoring

Oxford Desk Reference: Critical Care ◽

10.1093/med/9780198723561.003.0007 ◽

2019 ◽

pp. 105-136

Author(s):

Carl Waldmann ◽

Andrew Rhodes ◽

Neil Soni ◽

Jonathan Handy

Keyword(s):

Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

Cardiovascular Monitoring ◽

Central Venous ◽

Volume Responsiveness ◽

Non Invasive ◽

Pulmonary Artery Catheters ◽

Systemic Filling ◽

Systemic Filling Pressure

Cardiovascular instability is one of the main reasons for admission to intensive care. Situations such as hypovolaemia, heart failure, and vasoplegia are often mixed, between them making the diagnosis more challenging. Attention to details and careful monitoring are essential at this stage. This chapter discusses cardiovascular monitoring and includes discussion on electrocardiograph monitoring, arterial pressure monitoring, insertion of central venous catheters, common problems with central venous access, pulmonary artery catheters, echocardiography, clinical applications of echocardiography in the intensive care unit, Doppler, pulse pressure algorithms, non-invasive methods, monitoring mean systemic filling pressure, and detection of volume responsiveness.

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In defense of the use of peripherally inserted central catheters in pediatric patients

The Journal of Vascular Access ◽

10.1177/1129729820936411 ◽

2020 ◽

pp. 112972982093641

Author(s):

Alessandro Crocoli ◽

Simone Cesaro ◽

Monica Cellini ◽

Francesca Rossetti ◽

Luca Sidro ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Late Complications ◽

Central Venous ◽

Central Venous Access Device ◽

Peripherally Inserted Central Catheters ◽

Non Invasive ◽

Venous Access Device ◽

Central Catheters ◽

Venous Access Devices

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

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Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients

The Journal of Vascular Access ◽

10.1177/11297298211034306 ◽

2021 ◽

pp. 112972982110343

Author(s):

Matthew D Ostroff ◽

Nancy Moureau ◽

Mauro Pittiruti

Keyword(s):

Vascular Access ◽

Femoral Vein ◽

Central Venous Access ◽

Rapid Assessment ◽

Venous Access ◽

Central Vein ◽

Exit Site ◽

Central Venous ◽

Venous Catheterization ◽

Subcutaneous Tunneling

In the last decade, different standardized protocols have been developed for a systematic ultrasound venous assessment before central venous catheterization: RaCeVA (Rapid Central Vein Assessment), RaPeVA (Rapid Peripheral Vein Assessment), and RaFeVA (Rapid Femoral Vein Assessment). Such protocols were designed to locate the ideal puncture site to minimize insertion-related complications. Recently, subcutaneous tunneling of non-cuffed central venous access devices at bedside has also grown in acceptance. The main rationale for tunneling is to relocate the exit site based on patient factors and concerns for dislodgement. The tool we describe (RAVESTO—Rapid Assessment of Vascular Exit Site and Tunneling Options) defines the different options of subcutaneous tunneling and their indications in different clinical situations in patients with complex vascular access.

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