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BJA Advance Access published online on March 26, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep046
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Comparison of the bedside central venous catheter placement techniques: landmark vs electrocardiogram guidance{dagger}

J.-H. Lee1, J.-H. Bahk2,*, H.-G. Ryu2, C.-W. Jung2 and Y. Jeon2

1 Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
2 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul 110-744, Republic of Korea

* Corresponding author. E-mail: bahkjh{at}plaza.snu.ac.kr

Background: Electrocardiogram (ECG)-guided central venous catheter (CVC) placement has been reported to be accurate and successful. It has been shown that the CVC tip can be reliably placed at the level of the carina using a simple formula based on the puncture site, the ‘brachiocephalic notch’ on the clavicle, and the carina as landmarks. This study was performed to compare the accuracy of CVC tip localization between ECG- and landmark-guided catheterization.

Methods: Patients were randomized either to the ECG (n=121) or to the landmark (n=128) group. All catheterizations were performed via the right internal jugular vein (IJV). In the ECG group, CVCs were placed where P-wave returned to a normal configuration on right atrial ECG. In the landmark group, CVCs were placed at a depth derived by adding the distance between insertion point and the notch on the clavicle and the vertical length between the notch and the carina on a routine chest radiograph. On the postoperative portable chest radiograph, incidences of correct CVC tip position, defined as in the superior vena cava, were checked.

Results: CVCs were correctly placed in 96.1% of the landmark group (123/128) and in 95.9% of the ECG group (116/121). The mean CVC tip position relative to the carina was 0.0 [95% confidence interval (CI) –0.28 to 0.19] cm in the landmark group and 0.0 (95% CI –0.19 to 0.28) cm in the ECG group.

Conclusions: During central venous catheterization via the right IJV, landmark guidance was comparable with ECG guidance with regard to CVC tip positioning in the superior vena cava.

Keywords: equipment, cannulae intravascular; monitoring, electrocardiography; veins, jugular cannulation

{dagger} Presented in part at the annual meeting of European Association of Cardiothoracic Anaesthesiologists (EACTA 2008), Antalya, Turkey, June 11–14, 2008.


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