• S A Corsten, B van Dijk, N C Bakker, J J de Lange, and G J Scheffer.
• Department of Anesthesiology, Free University Hospital, Amsterdam, Netherlands.
• J Clin Anesth. 1994 Nov 1;6(6):469-72.

Study ObjectiveTo evaluate the clinical use of a new ECG-guided central venous catheter with regard to positioning in the superior vena cava (SVC).DesignProspective study.SettingOperating rooms of a university hospital and a general hospital.Patients89 elective and emergency adult surgical patients requiring central venous catheterization perioperatively.InterventionsWe performed ECG-guided placement of the central venous catheter from several insertion sites. After we observed an intra-atrial p-wave (p-atriale), the catheter was withdrawn 3 cm back into the SVC. Postoperative anterior-posterior chest radiographs were performed for verification of tip localization.Measurements And Main ResultsIn all 81 patients who exhibited a p-atriale that reverted to a normal-size p-wave (p-SVC) after withdrawal of the catheter 3 cm, the tip was located in the SVC or the SVC-right atrial junction on the chest radiograph. In 7 of the 8 cases without a p-atriale, the catheter tip was shown to be located at an incorrect position on the chest radiograph. The size of the p-atriale was always at least twice that of the p-SVC.ConclusionsUse of this wire-conducted intravascular ECG signal is a reliable tool for positioning the central venous catheter via various insertion sites. The technique proved to be an inexpensive, easy, and clear method. When a p-atriale is seen, uncomplicated insertions do not require radiologic guidance to control catheter tip position.

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